Faecal Calprotectin and NICE

New guidance from the National Institute for Health and Care Excellence (NICE) was released on the 2nd October regarding the use of Faecal Calprotectin as a diagnostics test for inflammatory diseases of the bowel. It advises doctors to use simple stool tests as an option to distinguish between potentially serious inflammatory bowel disease (IBD) and less serious irritable bowel syndrome (IBS). The faecal calprotectin test is used for people with recent lower gastrointestinal symptoms that could be due to either type of disorder and in whom assessment by a specialist is being considered.

The recommended tests measure the levels of the protein calprotectin which is found in inflammatory cells. The protein is traceable in stool samples for several days. When the bowel is inflamed, higher than normal levels of the protein pass through the walls of the intestine and the quantities present can be used to help distinguish between inflammatory bowel diseases and non-inflammatory bowel diseases.

The Director of the NICE Health Technology Evaluation Centre, Professor Carole Longson, states that it is important to distinguish inflammatory bowel diseases from Irritable Bowel Syndrome so that patients can be appropriately managed and monitored:

“Bowel disorders can be difficult to diagnose. But the treatments and outcomes can be very different. Faecal calprotectin testing helps doctors to distinguish between non-inflammatory disorders like Irritable Bowel Syndrome where sufferers will not come to serious harm and inflammatory bowel diseases such as Ulcerative Colitis or Crohn’s disease – which need to be quickly referred to specialists.

“Currently a number of tests are carried out in both hospitals and GPs’ surgeries to rule out conditions rather than to diagnose. This means people often face uncertainty, lots of visits to hospitals and their GP and repeated tests – some of them invasive and uncomfortable. Many people with IBD, particularly children with Crohn’s disease, sometimes have to wait for several years for their condition to be diagnosed.

“Looking at the available evidence, we found that faecal calprotectin testing is a good way to distinguish between inflammatory bowel disease and Irritable Bowel Syndrome. As well as being of benefit to patients, the tests will also save the NHS money. They will reduce both the time spent searching for a diagnosis and the numbers of invasive procedures such as colonoscopy. The test is also likely to reduce the demands on colonoscopy departments which will be able to focus on people being investigated for more serious conditions such as bowel cancer.”
Because inflammatory markers are also present in bowel cancer, the draft guidance does not apply to people who are being considered for referral for suspected cancer.”

The diagnostics guidance for faecal calprotectin tests for inflammatory diseases of the bowel can be downloaded here.