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Faecal calprotectin for differentiating between irritable bowel syndrome and inflammatory bowel disease: a useful
Ashwini Banerjee1, M Srinivas1, Richard Eyre2
1Department of Gastroenterology, Rotherham Hospital, Rotherham, UK.
Objective:
To determine the best faecal calprotectin (FCP) cut-off level for differentiating between irritable bowel syndrome (IBS) and organic disease, particularly inflammatory bowel disease (IBD), in patients presenting with chronic diarrhoea.
Design:
Retrospective analysis of patients who had colonoscopy, histology and FCP completed within 2 months.
Setting:
District general hospital.
Patients:
Consecutive new patients with chronic diarrhoea lasting longer than 4 weeks.
Interventions:
Patients were seen by a single experienced gastroenterologist and listed for colonoscopy with histology. Laboratory investigations included a single faecal specimen for calprotectin assay (lower limit of detection: 8 µg/g), the results used for information only.
Main Outcome Measures:
Six FCP cut-off levels (range 8-150 µg/g) were compared against the 'gold standard' of histology: inflammation 'present' or 'absent'.
Results:
Of 119 patients studied, 98 had normal colonoscopy and histology. The sensitivity of FCP to detect IBD at cut-off levels 8, 25 and 50 µg/g was 100% (with corresponding specificity 51%, 51%, 60%). In contrast, the lowest FCP cut-off, 8 µg/g, had 100% sensitivity to detect colonic inflammation, irrespective of cause (with negative predictive value (NPV) 100%). Importantly, 50/119 patients (42%) with FCP <8 µg/g had normal colonoscopy and histology.
Conclusions:
Our results suggest that using FCP to screen patients newly referred for chronic diarrhoea could exclude all without IBD and, at a lower cut-off, all without colonic inflammation, thus avoiding the need for colonoscopy. Such a major reduction has implications for resource allocation.
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