BACKGROUND: Calprotectin is a heat stable intracellular protein shed by neutrophils into the intestinal lumen in response to inflammation. Lack of specificity makes its role in the assessment of inflammatory bowel disease uncertain. However, the strength of faecal calprotectin testing may lie in its negative predictive value (NPV) rather than positive predictive value (PPV) of organic intestinal disease. OBJECTIVES: To determine whether a normal faecal calprotectin in new patients with symptoms safely predicts for functional intestinal disease. METHODS: To determine the predictive values of normal and raised faecal calprotectin by retrospective review of outcomes in consecutive primary care referrals into secondary care. Patients aged 16-60 years (mean age 41 years; 70% female patients) with intestinal symptoms were identified. 500 referrals had a normal faecal calprotectin and 130 had a raised result. 'Fast track' referrals were excluded. Outcome measures were the NPV of a normal faecal calprotectin and PPV of a raised faecal calprotectin. RESULTS: Normal faecal calprotectin had an NPV of 0.964 for excluding symptomatic organic intestinal disease. Significant incidental non-intestinal (3.6%) and intestinal (6.4%) diseases were also identified. Mean follow-up was 4.8 years with no diagnostic revisions. In the raised faecal calprotectin cohort, the PPV for organic intestinal disease was 0.7. CONCLUSIONS: A normal faecal calprotectin safely predicts for functional intestinal disease. It may represent a powerful screening tool for excluding organic intestinal disease in primary care. A prospective primary care based study is needed.
BACKGROUND: Calprotectin is a heat stable intracellular protein shed by neutrophils into the intestinal lumen in response to inflammation. Lack of specificity makes its role in the assessment of inflammatory bowel disease uncertain. However, the strength of faecal calprotectin testing may lie in its negative predictive value (NPV) rather than positive predictive value (PPV) of organic intestinal disease. OBJECTIVES: To determine whether a normal faecal calprotectin in new patients with symptoms safely predicts for functional intestinal disease. METHODS: To determine the predictive values of normal and raised faecal calprotectin by retrospective review of outcomes in consecutive primary care referrals into secondary care. Patients aged 16-60 years (mean age 41 years; 70% female patients) with intestinal symptoms were identified. 500 referrals had a normal faecal calprotectin and 130 had a raised result. 'Fast track' referrals were excluded. Outcome measures were the NPV of a normal faecal calprotectin and PPV of a raised faecal calprotectin. RESULTS: Normal faecal calprotectin had an NPV of 0.964 for excluding symptomatic organic intestinal disease. Significant incidental non-intestinal (3.6%) and intestinal (6.4%) diseases were also identified. Mean follow-up was 4.8 years with no diagnostic revisions. In the raised faecal calprotectin cohort, the PPV for organic intestinal disease was 0.7. CONCLUSIONS: A normal faecal calprotectin safely predicts for functional intestinal disease. It may represent a powerful screening tool for excluding organic intestinal disease in primary care. A prospective primary care based study is needed.
Authors: Jeremy A Tibble; Gudmundur Sigthorsson; Russell Foster; Ian Forgacs; Ingvar Bjarnason Journal: Gastroenterology Date: 2002-08 Impact factor: 22.682
Authors: Charlotte M T Otten; Liselotte Kok; Ben J M Witteman; Ruben Baumgarten; Ellen Kampman; Karel G M Moons; Niek J de Wit Journal: Clin Chem Lab Med Date: 2008 Impact factor: 3.694
Authors: P Jellema; M W van Tulder; H E van der Horst; J Florie; C J Mulder; D A W M van der Windt Journal: Colorectal Dis Date: 2011-03 Impact factor: 3.788
Authors: R Spiller; Q Aziz; F Creed; A Emmanuel; L Houghton; P Hungin; R Jones; D Kumar; G Rubin; N Trudgill; P Whorwell Journal: Gut Date: 2007-05-08 Impact factor: 23.059
Authors: James Turvill; Lisa Rook; Maxine Rawle; Gerry Robins; Simon Smale; Prashant Kant; Anne Phillips Journal: Frontline Gastroenterol Date: 2017-01-30
Authors: Ashwini Banerjee; M Srinivas; Richard Eyre; Robert Ellis; Norman Waugh; K D Bardhan; P Basumani Journal: Frontline Gastroenterol Date: 2014-04-02