Fecal calprotectin testing in the diagnosis of inflammatory bowel disease

January 01, 0001

Fecal calprotectin testing in the diagnosis of inflammatory bowel disease

These Dutch researchers evaluated the use of assaying fecal calprotectin, a marker of intestinal inflammation, in the testing for inflammatory bowel disease and whether the test can affect the number of endoscopies performed. They performed a meta-analysis of diagnostic accuracy studies garnered from searching in Medline and Embase through October 2009 for prospective studies of patients investigated for inflammatory bowel disease. Measurement of fecal calprotectin level was compared with endoscopy and histopathology from biopsies.

The researchers report: "13 studies were included: six in adults (n=670), seven in children and teenagers (n=371). Inflammatory bowel disease was confirmed by endoscopy in 32% (n=215) of the adults and 61% (n=226) of the children and teenagers. In the studies of adults, the pooled sensitivity and pooled specificity of calprotectin was 0.93 and 0.96 and in the studies of children and teenagers was 0.92 and 0.76. The lower specificity in the studies of children and teenagers was significantly different from that in the studies of adults. Screening by measuring faecal calprotectin levels would result in a 67% reduction in the number of adults requiring endoscopy. Three of 33 adults who undergo endoscopy will not have inflammatory bowel disease but may have a different condition for which endoscopy is inevitable. The downside of this screening strategy is delayed diagnosis in 6% of adults because of a false negative test result. In the population of children and teenagers, 65 instead of 100 would undergo endoscopy. Nine of them will not have inflammatory bowel disease, and diagnosis will be delayed in 8% of the affected children."

The researchers concluded: "Testing for faecal calprotectin is a useful screening tool for identifying patients who are most likely to need endoscopy for suspected inflammatory bowel disease. The discriminative power to safely exclude inflammatory bowel disease was significantly better in studies of adults than in studies of children."

This meta-analysis identifies a role for the use of fecal calprotectin testing in the workup for suspected inflammatory bowel disease in adults.

For the full abstract, click here.

BMJ 341:c3369, 15 July 2010
© 2010 van Rheenen et al.
Faecal calprotectin for screening of patients with suspected inflammatory bowel disease: diagnostic meta-analysis. Patrick F van Rheenen, Els Van de Vijver, Vaclav Fidler. Correspondence to P F van Rheenen: [email protected]

Category: D. Digestive. Keywords: fecal calprotectin, inflammatory bowel disease, screening, endoscopy, biopsy, meta-analysis, journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 17 August 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.