Elevated Faecal Calprotectin Levels are a Reliable Non-Invasive Screening Tool for Small Bowel Crohn’s Disease in Patients Undergoing Capsule Endoscopy

Abstract

Background: Approximately 10% of Crohn’s disease (CD) patients have this disease affecting the small bowel (SB) beyond the reach of Ileo-colonoscopy. Capsule endoscopy (SBCE) is the recommended investigation for SB disease. An accurate and inexpensive biomarker would help identify at-risk patients. Aim: To examine the efficacy of faecal calprotectin (FC) and C-reactive protein (CRP) as predictors of SBCE findings in suspected and known CD. Methods: A prospective observational study. Consecutive patients referred for SBCE gave FC and CRP samples. The diagnostic accuracy for SB CD based on SBCE result was calculated for both FC and CRP. Results: Of 100 invitees, FC and SBCE results were available in 64 cases. Correlation between FC >50 µg/g and SBCE result was poor К = 0.163; sensitivity, specificity, positive predictive value (PPV) and negative predictive values for ileitis were 60, 61, 32 and 83% respectively. PPV and specificity improved at FC >100 µg/g, 76 and 40%, correlation remained fair, К = 0.259. Receiver operating characteristic analysis had a sensitivity of 47% and specificity of 90% for FC >194 µg/g. CRP alone or in combination was an inaccurate predictor of ileitis. Conclusion: Our study suggests that FC level >194 µg/g may be a useful SBCE filter test, identifying patients at risk of SB CD.

Diagnostic Accuracy of Fecal Calprotectin for the Detection of Small Bowel Crohn's Disease through Capsule Endoscopy: An Updated Meta-Analysis and Systematic Review

“…16 The predictive value of FC is well established in patients with colonic involvement of Crohn's disease, 17 and the addition of small bowel capsule endoscopy has been confirmed in several studies using inflammatory indices such as a Lewis score. 16,[18][19][20][21][22][23][24][25] Recent prospective studies have suggested that FC can be used as a screening tool before patients undergo capsule endoscopy; [26][27][28][29][30] however, these studies have been limited by sample size and statistical power. Therefore, we conducted an updated meta-analysis to provide pooled diagnostic accuracy and a cutoff value of FC for the diagnosis of small bowel Crohn's disease.…”

Is fecal calprotectin an accurate marker in the management of Crohn's disease?

“…All the reported values of the sensitivity and specificity, according to different FC levels, are summarized in Table …”

“…All the reported values of the sensitivity and specificity, according to different FC levels, are summarized in Table 3. 22,[24][25][26][27][28][29][30][31][32][33][34] The small number of patients (four studies enrolled less than 30 patients and only three more than 100), as well as the retrospective design of five studies, 22,25,31,32,35 might limit the reliability of data (Table S1). Moreover, a direct comparison is not possible owing to the different criteria used to establish the diagnosis of CD, different scores, and cutoff values.…”

Atypical Clinical Presentation of Crohn’s Disease as Diffuse Abdominal Lymphadenopathy and Venous Thrombosis: A Difficult to Diagnose Case

“…Upper GI endoscopy was nondiagnostic as well. While capsule endoscopy comes in handy to diagnose such cases and can be utilized, it is not available widely even in many tertiary care hospitals [10-11]. This case helps remind us of the variable clinical presentation of CD and highlights the fact that despite the commonality of this disease, it still can be a diagnostic challenge.…”