Utility of Fecal Calprotectin in Evaluation of Chronic Gastrointestinal Symptoms in Primary Care

Ramraj, Ramya; Garcia, Amy M.; Mosen, David M.; Waiwaiole, Lisa; Smith, Ning

doi:10.1177/0009922817744607

Cited by 11 publications

(12 citation statements)

References 16 publications

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“…8 A study of routine data from an American health plans database of FC testing for chronic gastrointestinal symptoms in primary care suggests that it is used in routine general practice in at least one other country. 9 The NICE recommendations were based on an evaluation of secondary care test accuracy studies and assumptions that referral decisions would follow FC test results. This resulted in a slow uptake and inconsistent use of FC testing in primary care.…”

Section: Introductionmentioning

confidence: 99%

Test accuracy of faecal calprotectin for inflammatory bowel disease in UK primary care: a retrospective cohort study of the THIN data

et al. 2021

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ObjectiveTo estimate the test accuracy of faecal calprotectin (FC) for inflammatory bowel disease (IBD) in the primary care setting using routine electronic health records.DesignRetrospective cohort test accuracy study.SettingUK primary care.Participants5970 patients (≥18 years) without a previous IBD diagnosis and with a first FC test between 1 January 2006 and 31 December 2016. We excluded multiple tests and tests without numeric results in units of µg/g.InterventionFC testing for the diagnosis of IBD. Disease status was confirmed by a recorded diagnostic code and/or a drug code of an IBD-specific medication at three time points after the FC test date.Main outcome measuresSensitivity, specificity, and positive and negative predictive values for the differential of IBD versus non-IBD and IBD versus irritable bowel syndrome (IBS) at the 50 and 100 µg/g thresholds.Results5970 patients met the inclusion criteria and had at least 6 months of follow-up data after FC testing. 1897 had an IBS diagnosis, 208 had an IBD diagnosis, 31 had a colorectal cancer diagnosis, 80 had more than one diagnosis and 3754 had no subsequent diagnosis. Sensitivity, specificity, and positive and negative predictive values were 92.9% (88.6% to 95.6%), 61.5% (60.2% to 62.7%), 8.1% (7.1% to 9.2%) and 99.6% (99.3% to 99.7%), respectively, at the threshold of 50 µg/g. Raising the threshold to 100 µg/g missed less than 7% additional IBD cases. Longer follow-up had no effect on test accuracy. Overall, uncertainty was greater for specificity than sensitivity. General practitioners’ (GPs’) referral decisions did not follow the anticipated clinical pathways in national guidance.ConclusionsGPs can be confident in excluding IBD on the basis of a negative FC test in a population with low pretest risk but should interpret a positive test with caution. The applicability of national guidance to general practice needs to be improved.

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Section: Introductionmentioning

confidence: 99%

Test accuracy of faecal calprotectin for inflammatory bowel disease in UK primary care: a retrospective cohort study of the THIN data

et al. 2021

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“…Furthermore, FC is found to be a far superior test than standard blood tests (albumin, ESR, CRP, hemoglobin, white cell count or platelet count) in diagnosing IBD among children suspected of having IBD (15). A number of studies have evaluated the usefulness of FC in the primary-care setting where IBD can be safely excluded and avoid unnecessary referrals or endoscopy (16)(17)(18). The most recent study by Walker et al (18) demonstrated that a FC >100 µg/g is able to fully discriminate (100% sensitivity) children with IBD from those who do not have IBD in a primarycare setting.…”

Section: Discussionmentioning

confidence: 99%

Fecal Calprotectin in Combination With Standard Blood Tests in the Diagnosis of Inflammatory Bowel Disease in Children

Ross

Keenan

2021

Front. Pediatr.

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Introduction: Fecal calprotectin (FC) is a useful non-invasive screening test but elevated levels are not specific to inflammatory bowel disease (IBD). The study aimed to evaluate the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of FC alone or FC in combination with other standard blood tests in the diagnosis of IBD.Methods: Children aged <17 years who had FC (normal range <50 μg/g) measured and underwent endoscopy over 33 months in Christchurch, New Zealand were identified retrospectively (consecutive sampling). Medical records were reviewed for patient final diagnoses.Results: One hundred and two children were included; mean age was 12.3 years and 53 were male. Fifty-eight (57%) of the 102 children were diagnosed with IBD: 49 with Crohn's disease, eight with ulcerative colitis and one with IBD-unclassified. FC of 50 μg/g threshold provided a sensitivity of 96.6% [95% confident interval (CI) 88.3–99.4%] and PPV of 72.7% (95% CI 61.9–81.4%) in diagnosing IBD. Two children with IBD however were found to have FC <50 μg/g. Sensitivity in diagnosing IBD was further improved to 98.3% (95% CI 90.7–99.1%) when including FC >50 μg/g or elevated platelet count. Furthermore, PPVs in diagnosing IBD improved when FC at various thresholds was combined with either low albumin or high platelet count.Conclusion: Although FC alone is a useful screening test for IBD, a normal FC alone does not exclude IBD. Extending FC to include albumin or platelet count may improve sensitivity, specificity, PPV and NPV in diagnosing IBD. However, prospective studies are required to validate this conclusion.

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“…In a retrospective study of 898 patients, none of whom had a diagnosis of IBD and all of whom had fecal calprotectin measured in the primary care setting, 84% had normal calprotectin levels. 8 None of these patients were diagnosed with IBD or any other GI disease in the following 12 months. 8 These and other data suggest that fecal calprotectin is an excellent screening tool for IBD and can help avoid unnecessary referrals and endoscopies.…”

Section: Shelly Deanmentioning

confidence: 99%

“…7 In a number of prospective studies performed in different clinical settings, the sensitivity of a positive fecal calprotectin for IBD approaches 100%. 8 If the fecal calprotectin level is low (,15.6), the negative predictive value for IBD approaches 100%. 8 The specificity and positive predictive value of a positive test result is much lower because there are a variety of other etiologies for intestinal inflammation besides IBD.…”

Section: Shelly Deanmentioning

confidence: 99%

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Teenager With Abdominal Pain and Decreased Appetite

et al. 2020

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A 16-year-old girl presented to her primary care physician with a one-month history of decreased appetite and abdominal pain. She had normal bowel movements and no vomiting, but her periumbilical pain limited her ability to finish most meals. She had gradual weight loss over the previous 2 years, and during the previous 4 years, she intermittently received counseling for depression after the loss of her mother. Her initial physical examination and laboratory evaluation were unremarkable. She was referred to a nutritionist, adolescent medicine, and pediatric gastroenterology. Her presentation evolved over time, which ultimately led to a definitive diagnosis.

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Utility of Fecal Calprotectin in Evaluation of Chronic Gastrointestinal Symptoms in Primary Care

Cited by 11 publications

References 16 publications

Test accuracy of faecal calprotectin for inflammatory bowel disease in UK primary care: a retrospective cohort study of the THIN data

Test accuracy of faecal calprotectin for inflammatory bowel disease in UK primary care: a retrospective cohort study of the THIN data

Fecal Calprotectin in Combination With Standard Blood Tests in the Diagnosis of Inflammatory Bowel Disease in Children

Teenager With Abdominal Pain and Decreased Appetite

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