Introduction Faecal Calprotectin (FC) is a simple, non-invasive test which can differentiate Irritable Bowel Syndrome (IBS) from Inflammatory Bowel Disease (IBD). High negative predictive values suggest potential cost-effective benefits in Primary Care, reducing unnecessary referrals to secondary care and expensive/invasive diagnostic tests eg. colonoscopy. FC is well established in secondary care, but the literature for FC in primary care is extremely limited.
Aim Evaluation of a pilot study of a defined FC pathway in Primary Care.
Method A primary care referral pathway was devised to guide appropriate use of FC in Primary Care to exclude IBD in appropriate patients, particularly if secondary care referral was being considered. This was based on IBS guidelines (BSG), FC literature and recent NHS Centre for Evidence-Based Purchasing report (2010), consisting of a pathway proforma with initial screening tests (FBC, LFTs, TTG, CRP, TSH and stool microbiology). Inclusion/Exclusion criteria: 16–45 yrs age, IBS-compatible symptoms for ≥6 weeks/recurrent, no red flags.
FC results (Quantum Blue) classified as normal, intermediate or high and supplied with appropriate action guidance (Table 1). Subsequent clinic attendances, investigations, diagnostic outcomes and associated costs were evaluated.
Results Nineteen GP surgeries (19/22) referred 277 patients via FC pathway over 24 months (Jan 2013–Jan 2015). Forty-five samples rejected as inappropriate.
Diagnosis outcomes were available on 175/232 patients at the time of presented data analysis: Elevated 13.7% (24), Indeterminate 19.4% (34) and Normal 66.8% (117). In Elevated FC clinic attenders, IBD was detected in 50% (11/22). Indeterminates were repeated in only 68%: normal repeat 52.2% (12/23), 2 IBD cases detected. After a normal FC, 12.8% were referred to secondary care anyway, but no IBD detected.
In the normal FC group alone, assuming a normal FCP avoided a secondary care referral in 87.2% (102/117), the potential cost savings = £73,468 (assuming new patient clinic + 1 colonoscopy = £741.68).
Conclusion Preliminary data suggests a structured FC pathway is effective in distinguishing IBD and IBS in Primary Care with significant cost savings. Age ranges and FC cut-off points need further refinement. Based on this pilot data and latest NICE Diagnostic Appraisal 11, the Herefordshire Clinical Commission Group have commissioned a secondary care supervised FC service for primary care.
Disclosure of interest None Declared.
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