Clinical Case Database / Category: Patient Management

A practical guide to the use of faecal calprotectin testing

Publication details

Dr Frances Boa, Dr Anet Soubieres, Dr Andrew Poullis, Dr Fhorkan Uddin, Lorna Kent
Foundation Years Journal, volume 9, issue 2, p.12 (123Doc Education, London, February 2015)

Abstract

Abdominal pain with, or without a change in bowel habit is a common presenting symptom in primary care. A majority of these patients will be suffering from functional bowel disorders including functional dyspepsia and irritable bowel syndrome. Indeed, functional bowel disorders make up a significant proportion of referrals to gastroenterology outpatient clinics (up to 60%) (1). The dilemma in primary care is distinguishing a patient with functional symptoms from one with an underlying diagnosis of inflammatory bowel disease. Up to 50% of patients with a functional diagnosis are referred on for unnecessary endoscopic evaluation (1).
Faecal calprotectin is an inflammatory marker, which is released in excess into the bowel when there is inflammation present. It is measured in the stool and has been shown to help in the differential diagnosis of inflammatory bowel disease and irritable bowel syndrome (2).

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Authors

Dr Frances Boa

St George's University Hospitals NHS Foundation Trust, SW17 0QT
frances.boa@stgeorges.nhs.uk

Dr Anet Soubieres (Corresponding author)

St George's University Hospitals NHS Foundation Trust, SW17 0QT
anet.soubieres@stgeorges.nhs.uk

Dr Andrew Poullis

St George's University Hospitals NHS Foundation Trust, SW17 0QT
andrew.poullis@stgeorges.nhs.uk

Dr Fhorkan Uddin

Chartfield Surgery, 30 Chartfield Avenue, SW15 6HG
fhorkan.uddin@doctors.org.uk

Lorna Kent

Pathology Project Manager, Wandsworth CCG,
73 Upper Richmond Road, East Putney, London, SW15 2SR
lornakent@nhs.net

References

1. British Society of Gastroenterology. Chronic management: IBS/Functional symptoms. Available at: http://www.bsg.org.uk/clinical/commissioning-report/ibs/functional-symptoms.html. Last update 2014. Accessed 9 April 2014.
2. Faecal Calprotectin diagnostic tests for inflammatory diseases of the bowel. NICE diagnostics guidance Oct 2013.
3. Poullis A, Foster R, Mendall MA, Fagerhol MK. Emerging role of calprotectin in gastroenterology. J gastroenterol Hepatol. 2003;18(7):756.
4. Tibble JA, Bjarnason I. Fecal calprotectin as an index in intestinal inflammation. Drugs Today (Brac) 2001; 37(2):85-96
5. Boussac M, Garin J. Calcium-dependent secretion in human neutrophils: a proteomic approach. Electrophoresis 2000;21:665-672.
6. Irritable bowel syndrome in adults: Diagnosis and management of irritable bowel syndrome in primary care. NICE guidelines [CG61]. February 2008.
7. Longstreth GF, Thompson WG, Chey WD, et al. Functional bowel disorders. Gastroenterology 2006; 130:1480.
8. The use of fecal calprotectin and lactoferrin in patients with IBD. Review.Stragier E, Van Assche G.Acta Gastroenterol Belg. 2013 Sep;76(3):322-8. Review.
9. Faecal calprotectin and lactoferrin as markers for monitoring disease activity and predicting clinical recurrence in patients with Crohn's disease after ileocolonic resection: A prospective pilot study.Yamamoto T, Shiraki M, Bamba T, Umegae S, Matsumoto K.United European Gastroenterol J. 2013 Oct;1(5):368-74. doi: 10.1177/2050640613501818.
10. Fecal calprotectin in pediatric inflammatory bowel disease: a systematic review.Kostakis ID, Cholidou KG, Vaiopoulos AG, Vlachos IS, Perrea D, Vaos G.Dig Dis Sci. 2013 Feb;58(2):309-19. doi: 10.1007/s10620-012-2347-5. Epub 2012 Aug 17. Review.
11. Faecal calprotectin in term and preterm neonates.Kapel N, Campeotto F, Kalach N, Baldassare M, Butel MJ, Dupont C. J Pediatr Gastroenterol Nutr. 2010 Nov;51(5):542-7. doi: 10.1097/MPG.0b013e3181e2ad72. Review.
12. Fecal calprotectin in healthy children.Oord T, Hornung N. Scand J Clin Lab Invest. 2014 Apr;74(3):254-8. doi: 10.3109/00365513.2013.879732. Epub 2014 Feb 25.
13. National Institute for Health and Care Excellence. Clinical guideline 61: irritable bowel syndrome in adults: diagnosis and management of irritable bowel syndrome in primary care. 2008.
14. British Society of Gastroenterology. Chronic management: IBS/Functional symptoms. Available at: http://www.bsg.org.uk/clinical/commissioning-report/ibs/functional-symptoms.html. Last update 2014. Accessed 9 April 2014.

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