Faecal calprotectin levels in a high risk population for colorectal neoplasia

Abstract

Background-Faecal concentrations of the protein calprotectin have been found to be elevated in patients with colorectal neoplasia, suggesting that it might be used as a screening tool for colorectal cancer as well as adenomas. Aims-To measure the sensitivity and specificity of faecal calprotectin for the detection of adenomas in high risk individuals undergoing colonoscopy. Also, to investigate between and within stool variability of calprotectin concentrations. Subjects-A total of 814 patients planned for colonoscopy were included for the following indications: positive faecal occult blood test, 25; neoplasia surveillance, 605; newly detected polyp, 130; and family risk, 54. Methods-Two faecal samples from each of two stools were analysed using the PhiCal ELISA test device (Nycomed Pharma AS). Results-Adenoma patients had significantly higher calprotectin levels than normal subjects (median 9.1 (95% confidence interval 7.5-10.1) v 6.6 (5.6-7.4)mg/l). There was no significant decrease in calprotectin levels after polypectomy. Levels in cancer patients were significantly higher than those in all other subgroups (median 17.6 mg/l (11.5-31.0)). With a cut oV limit of 10 mg/l, the sensitivity for cancer was 74% and for adenoma 43%. Corresponding specificity values were 64% for no cancer and 67% for no neoplasia (cancer+adenoma). Specificity varied from 71% for one stool sample to 63% for four samples. Stool variability was small, suggesting that two spots from one stool were as discriminative as two spots from each of two stools. Conclusions-The sensitivity and specificity of faecal calprotectin levels as a marker for colorectal adenoma and carcinoma justifies its use in high risk groups, but specificity is too low for screening of average risk persons. Lack of a decrease in levels after polypectomy may be due to a more widespread leucocyte migration into the intestinal lumen than that at the polyp site, and needs further investigation. (Gut 2000;46:795-800)

A pilot randomised controlled trial to reduce colorectal cancer risk markers associated with B-vitamin deficiency, insulin resistance and colonic inflammation

“…Fish oil with long chain n-3 fatty acids (Paulsen et al, 1998;Bartsch et al, 1999;Stark et al, 2000) 3) Colonic inflammation/faecal calprotectin (Kristinsson et al, 1998;Kronborg et al, 2000) Diets deficient in calcium lead to an exposure of the colon to free bile and fatty acids, and to an inflammatory response (Wargovich et al, 1983;Newmark et al, 1984). The colonic inflammation increases initiation and promotion of colon cancer (Gillen et al, 1994;Biasco et al, 1995;Kristinsson et al, 1999;Okayasu et al, 2002).…”

Plasma Calprotectin Levels in Patients Suffering from Acute Pancreatitis

“…As Cal is found in all tissues of the human body, its assessment in several fluids could distinguish between normal and pathological conditions [2]. For instance, an elevated Cal concentration in stools is considered a marker of intestinal neoplasias [6] or inflammatory bowel diseases [7] and helps to distinguish between organic causes of chronic diarrhea and irritable bowel syndrome [8].…”

Diagnostic Value of Fecal Calprotectin as a Screening Biomarker for Gastrointestinal Malignancies

“…In Johne et al (2001) study over 453 symptomatic and asymptomatic CRC cases and healthy controls, a cutoff point of 50 µg/g was calculated with the associated sensitivity and specificity of 89 and 68%, respectively. In another study conducted by Kronborg et al (2000) a cut-off point of 10 µg/g was reported, however, the sensitivity of fecal calprotectin to distinguish CRC from other non-malignancy cases was ranged between 74% and 91% while the specificity was nearly 64%. Finally, Tibble et al (2001) found a sensitivity and specificity of 79% and 72%, respectively, for fecal calprotectin to distinguish CRC or adenomatous polyps from non-malignant lesions.…”

“…According to their findings, the median of fecal calprotectin level in the three mentioned groups were respectively 53.4, 30.0, and 4.5 milligram in litre (p<0.05). Similarly, Kronborg et al (2000) surveyed 814 candidates of colonoscopy, among whom, the median of fecal calprotectin level in CRC and normal group were 17.5 and 6.6 milligrams per litre, respectively (p<0.05). Tibble et al (2001) studied in the same area on 62 patients with CRC and 96 individuals as normal group.…”