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Use of faecal immunochemical testing as an alternative to faecal calprotectin in children
Kirn Sandhu1, Sandhia Naik1, Ruth M Ayling2
1Department of Paediatric Gastroenterology, Barts Health NHS Trust, London, UK.
Insights
Faecal haemoglobin is a reliable non-invasive marker for intestinal inflammation in children, correlating well with faecal calprotectin. Elevated faecal haemoglobin levels can help rule out significant bowel disease in pediatric patients.
Area of Science:
- Pediatric Gastroenterology
- Clinical Diagnostics
- Biomarker Research
Background:
- Faecal calprotectin is a standard non-invasive marker for pediatric intestinal inflammation.
- Faecal haemoglobin testing (FOBT) is established in adults for colorectal cancer screening and monitoring inflammatory bowel disease.
- The utility of FOBT in pediatric populations for assessing bowel disease has not been extensively studied.
Purpose of the Study:
- To evaluate the performance of faecal haemoglobin (FOBT) in children with bowel symptoms.
- To compare the diagnostic accuracy of FOBT with faecal calprotectin in a pediatric cohort.
- To determine if FOBT can serve as a reliable indicator of significant bowel disease in children.
Main Methods:
- Prospective collection of faecal samples from children in a pediatric gastroenterology clinic over 10 months.
- Simultaneous measurement of faecal haemoglobin using OC-Sensor and faecal calprotectin using Liason®Calprotectin.
- Correlation analysis (Spearman's rank) and comparison of results with histological findings from colonoscopies.
Main Results:
- A significant positive correlation was observed between faecal haemoglobin and faecal calprotectin (Spearman's rho = 0.656, P < 0.0001).
- Faecal haemoglobin levels >20 μg/g were associated with significant histological inflammation, with 32 out of 35 such patients also having elevated faecal calprotectin (>200 μg/g).
- A faecal haemoglobin level <4 μg/g was indicative of normal histology.
Conclusions:
- This study is the first to directly compare faecal haemoglobin and faecal calprotectin in pediatric patients.
- Faecal haemoglobin demonstrates a strong correlation with faecal calprotectin in children, suggesting its potential as a non-invasive biomarker.
- Faecal haemoglobin >20 μg/g is a reliable indicator of significant bowel inflammation in pediatric patients, supporting its use in ruling out significant bowel disease.
Background:
Faecal calprotectin has been widely used as a non-invasive marker of intestinal inflammation in children. Measurement of faecal haemoglobin using faecal immunochemical test is well established in adults for detection of colorectal cancer. In adults, faecal haemoglobin has been recommended as a reliable tool to aid identification of those at low risk of significant bowel disease and has also been used in inflammatory bowel disease to assess mucosal healing.
Aims:
We aimed to evaluate the performance of faecal haemoglobin in the paediatric population and compare it with faecal calprotectin.
Methods:
Children being assessed in the paediatric gastroenterology clinic for bowel symptoms had a sample sent for both faecal calprotectin and faecal haemoglobin. Samples were collected over a 10-month period from November 2018 to September 2019. Faecal haemoglobin was measured using an OC-Sensor. Faecal calprotectin was measured using Liason®Calprotectin.
Results:
One hundred forty three samples were returned for faecal haemoglobin and in 107 a paired faecal calprotectin was also available. Faecal haemoglobin correlated with faecal calprotectin, Spearman's rank coefficient 0.656 (P < 0.0001). There were 35 patients with faecal haemoglobin >20 μg/g and in 32 of these patients faecal calprotectin was >200 μg/g; 74 patients with faecal haemoglobin and 38 patients with faecal calprotectin underwent colonoscopy. Patients with normal histology had faecal haemoglobin <4 μg/g; faecal haemoglobin >20 µg/g was associated with signification inflammation.
Conclusion:
Our study is the first to compare faecal haemoglobin and faecal calprotectin in a paediatric population. Results suggest that faecal haemoglobin correlates with faecal calprotectin and, as in adults, may be useful to rule out significant bowel disease. A faecal haemoglobin >20 μg/g was consistent with significant histological inflammation.
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