Diagnosing IBD

Diagnosing_IBD
Faecal Calprotectin in Primary Care as a Decision Diagnostic for Inflammatory Bowel Disease and Irritable Bowel Syndrome

NICE DG11 faecal calprotectin diagnostic tests for inflammatory diseases of the bowel proposed that faecal calprotectin should be used as part of the assessment of IBD and IBS (NICE, 2013). This consensus document has been developed by experts in the field to assist local health economies to introduce the NICE guidance locally with a view to improve the patient journey and reduce unnecessary referrals to endoscopy services. Increased uptake of the test should produce increased knowledge and evidence, which can be used to enhance NICE DG11.

Professor Sue Hill, Chief Scientific Officer for England 
Three simple tests could save the NHS at least £6.9 billion

Amid NHS upheaval in the search for savings, are we missing a huge opportunity by overlooking tried and tested in vitro diagnostic tests?

BIVDA/Innovate UK Report 2018
Evaluation of the Quantum Blue® rapid test for faecal calprotectin

The Quantum Blue method was a suitable screening test for excluding inflammatory bowel disease. It may be of value to laboratories wishing to offer calprotectin but who do not have sufficient numbers to warrant ELISA methodology or in ‘one stop’ gastrointestinal clinics where an immediate result is required.

Wassell, et al. (2011) Annals of Clinical Biochemistry
Fecal calprotectin is equally sensitive in Crohn’s disease affecting the small bowel and colon

Levels and sensitivities of fCal are equal in patients with colonic and small bowel CD. Due to its high sensitivity and negative predictive value, fCal is a useful marker to rule out CD and select patients for endoscopy.

Jensen, et al. (2011) Scandinavian Journal of Gastroenterology
Value of fecal calprotectin in the evaluation of patients with abdominal discomfort: an observational study

In patients with abdominal discomfort, fecal calprotectin is a useful non-invasive marker to identify clinically significant findings of the gastrointestinal tract, irrespective of age.

Manz, et al. (2012) BMC Gastroenterology
Diagnostic accuracy and clinical application of faecal calprotectin in adult patients presenting with gastrointestinal symptoms in primary care

Correct use of the test and adherence to usage/referral protocols are likely to lead to fewer referrals to secondary care and consequently fewer investigations with potential cost savings.

Pavlidis, et al. (2013) Scandinavian Journal of Gastroenterology
Accuracy of three different fecal calprotectin tests in the diagnosis of inflammatory bowel disease

Overall accuracy for differentiating IBD from IBS or “other colitis” was the best for Quantum Blue® Calprotectin (97%/91%).

Jang, et al. (2016) Intestinal Research
Evaluation of a faecal calprotectin care pathway for use in primary care

The care pathway for FC in primary care had a 97% NPV and a 40% PPV. This was better than GP clinical judgement alone and doubled the PPV compared with the standard FC cut-off.

Turvill, et al. (2016) Primary Health Care Research and Development
Utility of faecal calprotectin in inflammatory bowel disease (IBD): what cut-offs should we apply?

FC is beneficial in distinguishing between functional GI conditions (IBS) and organic disease (IBD). In those with IBD, a 250 μg/g cut-off aids in determining clinical disease activity.

Dhaliwal, et al. (2015) Frontline Gastroenterology
Faecal calprotectin testing: the new NICE guidelines

The National Institute for Health and Care Excellence has issued new guidelines on the use of faecal calprotectin diagnostic tests for inflammatory diseases of the bowel. As Jason Cunningham explains, these guidelines may have substantial impact and cause the number of test requests to rocket.

Cunningham (2013) The Biomedical Scientist November Issue
Ruling out IBD: estimation of the possible economic effects of pre-endoscopic screening with F-calprotectin

The use of F-calprotectin as a screening test substantially could reduce the number of invasive measurements necessary in the diagnostic work-up of patients with suspected IBD, as well as the associated costs

Mindemark, et. al. (2012) Clinical Biochemistry
Role of fecal calprotectin as a biomarker of intestinal inflammation in inflammatory bowel disease

“We conducted a systematic review of the published literature regarding fecal calprotectin to evaluate its potential as a noninvasive marker of neutrophilic intestinal inflammation.”

Konikoff et. al. 2006 Wiley Online Library
Faecal calprotectin for screening of patients with suspected inflammatory bowel disease: diagnostic meta-analysis

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.

Van Rheenen et. al. 2010 BMJ
Utility of fecal calprotectin in differentiating active Inflammatory Bowel Disease from coexistent irritable bowel syndrome
Utility of faecal calprotectin analysis in adult inflammatory bowel disease

Faecal calprotectin is now playing a major role in the investigation and diagnosis of patients presenting to the physician with lower gastrointestinal symptoms and can obviate the need for costly invasive investigations in selected patients.

Smith and Gaya 2014 World Journal of Gastroenterology
The use of fecal calprotectin as a biomarker in gastrointestinal disease

This article summarizes the current literature on the use of fecal calprotectin in clinical practice.

Burri and Beglinger 2014
Faecal calprotectin testing for differentiating amongst inflammatory and non-inflammatory bowel diseases: systematic review and economic evaluation

Faecal calprotectin can be a highly sensitive way of detecting IBD, although there are inevitably trade-offs between sensitivity and specificity, with some false positives (IBS with positive calprotectin) if a low calprotectin cut-off is used. In most cases, a negative calprotectin rules out IBD, thereby sparing most people with IBS from having to have invasive investigations, such as colonoscopy.

Waugh et al. 2013