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Potential Utility of Fecal Calprotectin in Discriminating Colorectal Polyps From Other Major Etiologies in Children
Yu Bin Kim1, Ju Young Kim2, Sujin Choi3
1Department of Pediatrics, Ajou University Medical Center, Suwon, Korea.
Insights
Fecal calprotectin (FC) can help identify colorectal polyps in children with hematochezia. Specific FC cut-offs differentiate polyps from anal fissures and ulcerative colitis, aiding diagnosis.
Area of Science:
- Pediatric Gastroenterology
- Clinical Diagnostics
- Inflammatory Bowel Disease Research
Background:
- Colorectal polyps are a common cause of isolated hematochezia in children, necessitating colonoscopy for diagnosis.
- Fecal calprotectin (FC) is a biomarker for intestinal inflammation.
- The utility of FC in assessing colorectal polyps in pediatric hematochezia is under investigation.
Purpose of the Study:
- To evaluate the effectiveness of fecal calprotectin (FC) in assessing colorectal polyps in children with isolated hematochezia.
- To determine FC cut-off values for differentiating colorectal polyps from other causes of hematochezia.
Main Methods:
- A retrospective, cross-sectional study included 127 pediatric patients (<18 years) with isolated hematochezia who underwent colonoscopy and FC testing.
- Comparative analysis of FC levels was performed between patients with colorectal polyps, anal fissures, and ulcerative colitis (UC).
- Receiver operating characteristic (ROC) curve analysis was used to determine optimal FC cut-off values.
Main Results:
- Colorectal polyps were diagnosed in 27.6% of patients, followed by anal fissure (14.2%) and UC (12.6%).
- Significant differences in FC levels were observed between colorectal polyps (median 278.7 mg/kg), anal fissures (median 42.2 mg/kg), and UC (median 981 mg/kg).
- Optimal FC cut-offs were identified: 225 mg/kg for differentiating polyps from anal fissures (AUC 0.8) and 879 mg/kg for differentiating polyps from UC (AUC 0.687).
Conclusions:
- Fecal calprotectin shows potential as a non-invasive tool to aid in the etiological assessment of lower gastrointestinal bleeding in children.
- Specific FC cut-off values can help distinguish colorectal polyps from anal fissures and UC in pediatric patients.
- FC may assist clinicians in guiding diagnostic decisions for pediatric hematochezia.
Background:
Colorectal polyps are the most common cause of isolated hematochezia in children, which requires a colonoscopy for diagnosis. We aimed to investigate the potential utility of fecal calprotectin (FC) in assessing colorectal polyps detected by colonoscopy among children presenting with isolated hematochezia.
Methods:
Pediatric patients of the age of < 18 years who had undergone both colonoscopy and FC tests for isolated hematochezia from June 2016 to May 2020 were included in the present multicenter, retrospective, cross-sectional study. Comparative analysis was conducted between major causes of isolated hematochezia and FC cut-offs for discriminating colorectal polyps were explored.
Results:
A total 127 patients were included. Thirty-five patients (27.6%) had colorectal polyps, followed by anal fissure (14.2%), ulcerative colitis (UC; 12.6%), and others. A significant difference in FC levels was observed between patients with colorectal polyps (median, 278.7 mg/kg), anal fissures (median, 42.2 mg/kg), and UC (median, 981 mg/kg) (P < 0.001). According to receiver operating characteristic curve analysis, among patients diagnosed with colorectal polyp or anal fissure, the most accurate FC cut-off for discriminating colorectal polyps from anal fissures on colonoscopy was 225 mg/kg (sensitivity, 59.4%; specificity, 94.4%; positive predictive value [PPV], 95.0%; negative predictive value [NPV], 56.7%; area under the curve [AUC], 0.8; 95% confidence interval [CI], 0.678-0.923; P < 0.001), while among patients diagnosed with colorectal polyp or UC, the most accurate FC cut-off for discriminating colorectal polyps from UC on colonoscopy was 879 mg/kg (sensitivity, 81.2%; specificity, 56.2%; PPV, 78.8%; NPV, 60.0%; AUC, 0.687; 95% CI, 0.521-0.852; P < 0.001).
Conclusion:
FC may assist in assessing the cause of lower gastrointestinal tract bleeding in children who present with isolated hematochezia.
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