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How to use faecal calprotectin in management of paediatric inflammatory bowel disease
Amit Saha1, Mark P Tighe2, Akshay Batra1
1Paediatric Gastroenterology, Southampton University Hospital NHS Trust, Southampton, UK.
Insights
Faecal calprotectin (FC) is a sensitive, non-invasive test for diagnosing inflammatory bowel disease (IBD). While not perfectly specific, FC effectively screens for IBD, especially in children, and aids in monitoring disease activity.
Area of Science:
- Gastroenterology
- Clinical Diagnostics
- Biomarker Research
Background:
- Faecal calprotectin (FC) is a neutrophil protein indicating mucosal inflammation.
- It's a non-invasive stool test with high sensitivity for inflammatory bowel disease (IBD).
- FC levels correlate with IBD activity regardless of disease location or type.
Purpose of the Study:
- To evaluate the utility of faecal calprotectin (FC) in diagnosing and monitoring inflammatory bowel disease (IBD).
- To highlight FC's role as a sensitive screening tool, particularly in pediatric populations.
- To discuss the impact of cut-off values and the importance of excluding other conditions.
Main Methods:
- Review of faecal calprotectin's diagnostic and monitoring capabilities for IBD.
- Analysis of FC's sensitivity and specificity in various clinical contexts.
- Consideration of FC's correlation with disease activity indices and other gastrointestinal conditions.
Main Results:
- FC demonstrates high sensitivity and moderate specificity for IBD diagnosis.
- FC levels effectively track bowel inflammation and disease activity.
- The test is valuable for screening children with low IBD probability and monitoring disease relapse.
Conclusions:
- Faecal calprotectin is a valuable, sensitive, non-invasive tool for IBD screening and monitoring.
- Appropriate interpretation of FC cut-off values is crucial for diagnostic accuracy.
- Infective gastrointestinal conditions should be excluded before FC testing.
Abstract:
Faecal calprotectin (FC) is a neutrophil-derived protein released in stool in response to mucosal inflammation. It is a simple, cheap and non-invasive test with high sensitivity and moderate specificity, which can be useful in the diagnosis and monitoring of inflammatory bowel disease (IBD). FC levels correlate well with bowel inflammation (both macroscopic and histological activity) and are not influenced by disease location or type of IBD. Despite the shortcoming with regards to specificity, it is the high sensitivity of FC that makes it a valuable screening tool in the diagnosis of IBD. It is especially effective in identifying children with low probability of IBD who would not benefit from further investigations. The cut-off value selected has a significant impact on the diagnostic accuracy of the test, influencing its sensitivity and specificity, and must be interpreted judiciously. Its role in disease monitoring is as an add-on test to Paediatric Ulcerative Colitis Activity Index and Paediatric Crohn's Disease Activity Index scores and can be used to differentiate disease relapse from functional symptoms. High levels of FC are also seen in a number of other conditions, such as gastrointestinal infections and coeliac disease. It is recommended that infective causes affecting the gut must be excluded first, before FC is measured.
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