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Fecal calprotectin in pediatric inflammatory bowel disease: a systematic review
Ioannis D Kostakis1, Kyriaki G Cholidou, Aristeidis G Vaiopoulos
1Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Medical School, National and Kapodistrian University of Athens, 15b Agiou Thoma Street, 11527, Athens, Greece. i.d.kostakis@gmail.com
Insights
Fecal calprotectin testing can aid in diagnosing and monitoring pediatric inflammatory bowel disease (IBD). While a positive test suggests IBD or relapse, a negative result doesn't rule it out due to moderate specificity.
Area of Science:
- Pediatric Gastroenterology
- Clinical Diagnostics
- Inflammatory Markers
Background:
- Inflammatory bowel disease (IBD) often emerges in childhood or adolescence.
- Current IBD diagnostic and monitoring methods are invasive, uncomfortable, and expensive.
- Fecal calprotectin is an inflammatory marker investigated in pediatric IBD patients.
Purpose of the Study:
- To evaluate the utility of fecal calprotectin testing in pediatric patients with inflammatory bowel disease.
- To assess the diagnostic accuracy of fecal calprotectin for IBD diagnosis and relapse detection in children.
Main Methods:
- Systematic literature search of MEDLINE and EMBASE up to October 2011.
- Inclusion of original English-written studies on pediatric IBD patients measuring fecal calprotectin.
- Extraction of fecal calprotectin levels, sensitivity, specificity, and likelihood ratios.
Main Results:
- Thirty-four studies were included in the analysis.
- Fecal calprotectin levels were significantly higher in pediatric IBD patients compared to controls.
- The test demonstrated high sensitivity and positive likelihood ratio, but moderate specificity, particularly for active or newly diagnosed IBD.
Conclusions:
- Fecal calprotectin testing can support the diagnosis of IBD and confirm relapse in pediatric patients.
- A positive fecal calprotectin result is indicative of IBD or relapse due to high sensitivity.
- A negative fecal calprotectin result should not exclude IBD or relapse due to moderate specificity.
Background:
Inflammatory bowel disease frequently begins during childhood or adolescence. Current tests and procedures for diagnosing and monitoring inflammatory bowel disease are invasive, uncomfortable and costly. Fecal calprotectin is an inflammatory marker tested in several studies including pediatric patients with inflammatory bowel disease.
Methods:
A search for articles published up to October 2011 was conducted using MEDLINE and EMBASE databases. We included original English-written articles referred to pediatric patients with inflammatory bowel disease and measured fecal calprotectin levels. We extracted data concerning fecal calprotectin levels in patients with inflammatory bowel disease and in the controls groups, sensitivity, specificity, positive and negative likelihood ratio.
Results:
Thirty-four studies were included. Fecal calprotectin levels of patients with inflammatory bowel disease are much higher than those of healthy controls or patients with functional disorders or other gastrointestinal diseases. The results vary greatly when taking all studies into consideration. Nevertheless, in cases of newly diagnosed and/or active inflammatory bowel disease, the results are more homogeneous, with high sensitivity and positive likelihood ratio, low negative likelihood ratio, but moderate specificity. Moreover, 50 μg/g seems to be the most proper cut-off point for the fecal calprotectin test.
Conclusions:
The fecal calprotectin test could be used for supporting diagnosis or confirming relapse of inflammatory bowel disease in pediatric patients. A positive result could confirm the suspicion of either inflammatory bowel disease diagnosis or inflammatory bowel disease relapse, due to the high sensitivity of the test, but a negative result should not exclude these conditions, due to its moderate specificity.
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