No 9, 2012

Publication of the Month

 

September 09/12: 

Faecal calprotectin

  

Key message:

  • Measuring faecal calprotectin can be highly useful in the diagnosis and diseases management of patients with IBD.
  • Faecal calprotectin could help predict disease course.

Burri E, Beglinger C
Faecal calprotectin -- a useful tool in the management of inflammatory bowel disease
Swiss Med Wkly. 2012;142:w13557

  

Background:
Inflammatory bowel disease (IBD) should be suspected in any patient presenting with chronic or recurrent abdominal pain and diarrhoea. Faecal calprotectin has been proposed as a surrogate marker of intestinal inflammation. This review article summarizes the findings on faecal calprotectin of the last years.

Summary:

  • Calprotectin in faeces is a reliable surrogate marker of intestinal inflammation throughout the gastrointestinal tract. It is useful in differentiating between organic and non-organic gastrointestinal disease.
  • Faecal calprotectin levels are elevated in patients with active IBD. Calprotectin testing shows excellent diagnostic accuracy in patients with suspected IBD.
  • Faecal calprotectin levels correlate well with endoscopic and histological disease activity. In CD, the correlation is better for colonic than for ileal disease.
  • Low faecal calprotectin levels after treatment indicate response of endoscopic disease activity better among adult than paediatric patients.
  • Mucosal healing seems to indicate controlled IBD activity. It has been associated with sustained clinical remission as well as reduced rates of hospitalisation and surgical resection. Data on faecal calprotectin as a surrogate marker of MH are emerging, but the evidence is not yet conclusive.
  • Faecal calprotectin levels <150 μg/g indicate IBD remission with a low risk of relapse. Reports from prospective intervention studies using calprotectin-guided therapy strategies to investigate the long-term outcome of IBD are not yet available.

Conclusions:
Measurement of faecal calprotectin is highly useful for the diagnosis and disease monitoring of patients with IBD, and might additionally predict disease outcome.
Calprotectin’s advantage of non-invasive monitoring of disease activity is especially beneficial when considering the dynamics of repeated measurements.

Comment:
Faecal calprotectin improves the diagnosis of IBD and at the same time reduces the burden on patients and healthcare systems.

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As in all diagnostic testing, the diagnosis is made by the physican based on both test results and the patient history.