The Utility of Fecal Calprotectin in the Real-World Clinical Care of Patients with Inflammatory Bowel Disease

Abstract

Objectives. To determine the relationship between fecal calprotectin (FCAL) and imaging studies and other biochemical inflammatory markers and the impact of FCAL measurements on decision-making in IBD patient management in usual clinical practice. Methods. 240 persons with IBD were enrolled. The correlation between FCAL values and other markers for disease activity such as serum albumin (alb), hemoglobin (Hg), and C-reactive protein (CRP) and diagnostic imaging or colonoscopy was examined. FCAL ≥ 250 mcg/g of stool was considered a positive result indicating active IBD. Results. 183 stool samples (76.3%) were returned. The return rate in the pediatric and adult cohorts was 91% (n = 82) and 67.3% (n = 101), respectively (P < 0.0001). Positive FCAL was associated with colonoscopy findings of active IBD (P < 0.05), low albumin (P < 0.05), anemia (P < 0.01), and elevated CRP (P < 0.01). There was no significant difference for FCAL results by outcomes on small bowel evaluation among the 21 persons with small bowel CD. Most persons (87.5%) with normal FCAL and no change in therapy remained in remission during subsequent 3 months. Conclusions. FCAL is a useful marker of disease activity and a valuable tool in managing persons with IBD in clinical practice. Clinicians have to be cautious in interpreting FCAL results in small bowel CD.

Impact of Fecal Calprotectin Measurement on Decision-making in Children with Inflammatory Bowel Disease

“…Fecal calprotectin is a surrogate marker for mucosal inflammation and has been proven as a very beneficial, non-invasive, and relatively an inexpensive test in the work-up of IBD with a considerable high sensitivity (15, 16). Although high FCal can be found in other gastrointestinal disorders, in addition to IBD, such as gastrointestinal infections and polyposis, proper use of this test may reduce the need for frequent colonoscopies (15).…”

“…Although high FCal can be found in other gastrointestinal disorders, in addition to IBD, such as gastrointestinal infections and polyposis, proper use of this test may reduce the need for frequent colonoscopies (15). …”

Gastrointestinal Ultrasound Can Predict Endoscopic Activity in Crohn’s Disease

“…Fecal calprotectin is a well-established biomarker of intestinal inflammation that correlates well with endoscopy and may be useful in discriminating between active and inactive disease [6]. Still, higher accuracies are achieved in ulcerative colitis than CD [7] as well as in colonic versus small bowel CD [8].…”

Faecal calprotectin delivers on convenience, cost reduction and clinical decision‐making in inflammatory bowel disease: a real‐world cohort study

“…This also reiterates the observation by Abej et al that, once available, clinicians quickly learn to put faith in FC and use the test in clinical decision-making. 19 Indeed, in a recent study that surveyed Australian gastroenterologists, interestingly, both FC users (79%) and non-users (68%) reported that the use of FC would likely defer or avoid colonoscopies if the test was available under government reimbursement. 20 In addition, while some have raised concerns about the accuracy of FC in assessing small bowel CD, 21,22 other studies have refuted this assertion.…”