The Use of Fecal Calprotectin Testing in Paediatric Disorders

Abstract

Objectives: The aim of the study was to review the evidence regarding the clinical use and value of fecal calprotectin (FC) measurements in different gastrointestinal disorders in children. Methods: A literature search was conducted in the PubMed, MEDLINE, EMBASE, and Cochrane databases until October 31, 2019. Subtopics were identified and each assigned to individual authors. Results: A total of 28 recommendations were voted on using the nominal voting technique. Recommendations are given related to sampling, measurement methods, and results interpretation. The 14 authors anonymously voted on each recommendation using a 9-point scale (1 strongly disagree to 9 fully agree). Consensus was considered achieved if at least 75% of the authors voted 6, 7, 8, or 9. Conclusions: Consensus was reached for all recommendations. Limitations for the use of FC in clinical practice include variability in extraction methodology, performance of test kits as well as the need to establish local reference ranges because of the influence of individual factors, such as age, diet, microbiota, and drugs. The main utility of FC measurement at present is in the diagnosis and monitoring of inflammatory bowel disease (IBD) as well as to differentiate it from functional gastrointestinal disorders (FAPDs). FC, however, has neither utility in the diagnosis of infantile colic nor to differentiate between functional and organic constipation. A rise in FC concentration, may alert to the risk of developing necrotizing enterocolitis and help identifying gastrointestinal involvement in children with Henoch-Schönlein purpura. FC measurement is of little value in Cow's Milk Protein Allergy, coeliac disease (CD), and cystic fibrosis. FC does neither help to distinguish bacterial from viral acute gastroenteritis (AGE), nor to diagnose Helicobacter Pylori infection, small intestinal bacterial overgrowth (SIBO), acute appendicitis (AA), or intestinal polyps.

Impact of diagnostic delay to the clinical presentation and associated factors in pediatric inflammatory bowel disease: a retrospective study

“…The laboratory parameters collected comprised blood hemoglobin (Hb, reference values from 95–150 to 130–230 g/l depending on age and sex) [ 17 ], C-reactive protein (CRP, < 10 mg/l), erythrocyte sedimentation rate (ESR, < 15 mm/h), plasma albumin (Alb, from 35–46 to 37–51 g/l) and fecal calprotectin (< 100 µg/g [ 18 ]).…”

Application of faecal calprotectin as marker of gastrointestinal tract disorders

“…A slight influence of diet and physical activity has also been reported [6]. Furthermore, the concentration of FC in diaper-collected samples may be elevated because of water absorption [3]. [13].…”

“…There is a high degree of variability in FC concentrations between individuals [3]. Most publications assume a cut-off point of 50 µg/g in faeces for adults and children > 4 years of age, while there are no commonly accepted values for children below that age threshold [6].…”

“…An amount of ≥ 100 ml of blood loss/day may increase FC concentration, leading to false positive results [6]. The FC concentration may also be affected by bowel preparation; hence FC measurement should not be performed for several days after bowel cleansing and colonoscopy [3].…”

“…The clinical applicability of faecal calprotectin (FC) is best explored in inflammatory bowel disease (IBD). It has been proven that protein concentration rises in a flare-up of the disease, which makes FC a globally accepted diagnostic tool for diagnosing and monitoring IBD in various clinical scenarios [3]. The increased concentration of FC has also been intensively investigated in many other GI and extra GI conditions, including necrotising enterocolitis, coeliac disease, cystic fibrosis, food allergy, colorectal cancers, inflammation of the GI tract mucosa associated with non-steroidal anti-inflammatory drugs (NSAIDs) use, infections, acute pancreatitis, liver cirrhosis, and after significant physical exertion [1,2,4,5].…”