The utility of biomarkers in inflammatory bowel disease, with a focus on fecal calprotectin

Petryszyn P, et al. Faecal calprotectin as a diagnostic marker of inflammatory bowel disease in patients with gastrointestinal symptoms: meta-analysis. Eur J Gastroenterol Hepatol. 2019 Nov;31(11):1306-1312.

Full-text for Emory users.

“The study aimed to assess efficacy of faecal calprotectin as a diagnostic marker of IBD in patients with symptoms suggestive of such diagnosis. Inclusion criteria comprised experimental and observational studies, adults with gastrointestinal symptoms, calprotectin as index and colonoscopy as reference test, presence of data on/enabling the calculation of diagnostic accuracy parameters. For each study, sensitivity and specificity of faecal calprotectin were analysed as bivariate data. Nineteen studies were identified. The total number of patients was 5032. Calculated pooled sensitivity and specificity were 0.882 [95% confidence interval (CI), 0.827-0.921] and 0.799 (95% CI, 0.693-0.875), respectively. Following faecal calprotectin incorporation in the diagnostic work-up of 100 people with suspected IBD, 18 non-IBD patients will have a colonoscopy performed and one patient with the disease will not be referred for this examination. Faecal calprotectin concentration measurement is a useful screening test to rule out IBD, at the same time reducing the need for colonoscopy by 66.7%.”

Brookes MJ, et al. Practical guidance on the use of faecal calprotectin. Frontline Gastroenterol. 2018 Apr;9(2):87-91.

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“Faecal calprotectin is a sensitive and specific non-invasive marker of gastrointestinal inflammation.”

Summary recommendations: 

  • Stool sample for calprotectin is collected from the first bowel action of the day, and kept for no longer than 3 days at room temperature.
  • Threshold values are determined on the basis of local audit data, and assay used.
  • Faecal calprotectin is used to discriminate between functional gastrointestinal symptoms and IBD in primary and secondary care in adults with recent-onset lower gastrointestinal symptoms, where cancer is not suspected and for whom specialist assessment is being considered.
    • It should not be used in patients with acute diarrhoea, bloody diarrhoea or in older patients where the need to rule out polyps or cancer mandates colonoscopy anyway.
  • It is suggested that faecal calprotectin measurement is useful in patients with IBD, in whom it is unclear whether symptoms are due to active inflammation, or other causes such as coexisting IBS or bile salt malabsorption.
  • It is suggested that faecal calprotectin can be useful in decision-making regarding either stopping or increasing drug therapy for IBD. It is not recommended that faecal calprotectin is used routinely in the monitoring of all patients with IBD.

Lamb CA, Mansfield JC. Measurement of faecal calprotectin and lactoferrin in IBD. Frontline Gastroenterol. 2011 Jan;2(1):13-18.

Free full-text. 

What cautions and limitations are there of using faecal biomarkers?

“It is important to remember that despite all of this promising data, faecal biomarker quantification as a screening test for IBD cannot fully replace conventional endoscopy and radiology. IBD remains a histological diagnosis requiring intestinal biopsies, so a positive calprotectin or lactoferrin will require further tests not only to confirm or refute a diagnosis of IBD, but also to exclude other causes of raised biomarkers including malignancy, polyps, viral or bacterial gastroenteritis, NSAID enteropathy, untreated coeliac disease or gastro-oesophageal reflux disease. [27] Therefore the use of faecal biomarkers should be restricted to situations where the result along with clinical judgement informs a decision about treatment, allows avoidance of invasive tests, or where invasive tests have not provided a satisfactory conclusion—for example, a normal colonoscopy but clinical suspicion of small bowel inflammation.”

More PubMed results on fecal calprotectin in IBD.

See also: EUH Morning Report: What is the utility of fecal calprotectin in the diagnosis and management of inflammatory bowel disease?

1 thought on “The utility of biomarkers in inflammatory bowel disease, with a focus on fecal calprotectin

  1. Pingback: EUH Morning Report: What is the utility of fecal calprotectin in the diagnosis and management of inflammatory bowel disease? | The Bottom Line

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