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Clinical usefulness of the faecal calprotectin test in suspected paediatric inflammatory bowel disease
1Sidra Medical and Research Center, Doha, Qatar.
Insights
The faecal calprotectin (FC) test aids in selecting children with gastrointestinal symptoms for inflammatory bowel disease (IBD) evaluation. A negative FC test effectively rules out IBD, but a positive result requires further investigation.
Area of Science:
- Gastroenterology
- Pediatrics
- Diagnostic Testing
Background:
- The faecal calprotectin (FC) test is a valuable tool for assessing pediatric gastrointestinal symptoms.
- It helps identify children who may have inflammatory bowel disease (IBD) and require endoscopic evaluation.
Observation:
- Meta-analyses were searched to determine the diagnostic accuracy of the FC test.
- Likelihood ratios (LR) were calculated to assess the test's effectiveness in distinguishing IBD from non-IBD patients.
Findings:
- The FC test demonstrated a positive LR of 2.8 and a negative LR of 0.015.
- A negative FC result strongly indicated the absence of IBD, while a positive result was less definitive, especially with low pre-test probability.
Implications:
- The FC test is most useful when targeted toward children with a higher pre-test probability of IBD.
- Indiscriminate use in all children with gastrointestinal symptoms is not recommended; clinical judgment remains crucial.
Aim:
The faecal calprotectin (FC) test is increasingly being used in clinical practice to help select children with gastrointestinal symptoms who might have inflammatory bowel disease (IBD) and benefit from endoscopies. We provide an overview of the advantages and limitations of the FC test.
Methods:
PubMed was searched for meta-analyses that had investigated the diagnostic accuracy of the FC test and the pooled sensitivity and specificity for distinguishing IBD from non-IBD patients were used to calculate likelihood ratios (LR). These were applied to practical examples to explain how easily clinicians can use the results to modify pre-test probabilities of IBD and generate post-test probabilities for IBD.
Results:
The positive LR and negative LR of the FC test were 2.8 and 0.015, respectively. The usefulness of the FC test depended on the pre-test probability of IBD. When the pre-test probability of IBD was low, a positive FC test did not necessarily indicate IBD. However, because of the very small negative LR, a negative FC result virtually ruled out IBD in most cases.
Conclusion:
The FC test should not be used indiscriminately in children with gastrointestinal symptoms but should be targeted at those who are likely to have IBD.
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