Makindo Medical Notes.com

Used as a diagnostic test between Irritable bowel syndrome and Inflammatory bowel disease. An elevated level can suggest inflammatory bowel disease

Usage

• Patients with suspected inflammatory bowel disease and no red flags
• Patients aged 18-60 years presenting with lower gastrointestinal symptoms
• IBS or IBD is suspected but there is diagnostic uncertainty.
• Do not use if colorectal cancer or acute severe IBD are suspected
• If symptoms of ovarian cancer suspected then CA125 should be measured

Aetiology

• Calprotectin is a stable protein that accounts for about 60% of neutrophil cytosolic protein.
• Calprotectin is released into the faeces when neutrophils gather at the site of any gastro-intestinal tract inflammation.
• Faecal calprotectin is a very sensitive measure of intestinal inflammation

Raised levels

• Inflammatory bowel disease
• Infective colitis
• Diverticulitis
• Certain drugs e.g. NSAIDS
• Colorectal cancer

Cautions

• Note that treatment with NSAIDs may increase a patient's faecal calprotectin by approximately twofold.
• Non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen, should be stopped for 4 weeks prior to collecting your sample.

Terminology

• IBS: Irritable bowel syndrome
• IBD: Inflammatory bowel disease

Assessment

• Initial faecal calprotectin <100 microgram/g:IBD unlikely. IBD is unlikely in this group of patients and should be treated as IBS with a 6-week review. If persists symptoms and > 50 micrograms/g then referred routinely to gastroenterology. Patients under the age of 50 years where the faecal calprotectin is less than 50 microgram/L should be monitored and referred routinely to gastroenterology if the second line IBS treatment is unsuccessful. A FC<100 may also prompt the clinician to consider non-gastrointestinal, such as urogynaecological, disease in the differential.
• Initial faecal calprotectin 100-250 microgram/g: Experience has shown that initial elevations at this level can be normal on repeat, and it is recommended that in this intermediate group a repeat faecal calprotectin is undertaken within 4 weeks. NSAIDs can cause false elevations of faecal calprotectin and whilst repeating faecal calprotectin after withdrawal of NSAIDs would be ideal it was thought that this would add time to the patient pathway and a pragmatic view would be to repeat whilst the patient is on NSAIDs. Repeat faecal calprotectin: FC > 250: Urgent referral to gastroenterology, FC 100-250: Routine referral to gastroenterology, <100: IBD unlikely, plan care as if initial FC was less than 100 microgram/g
• Initial faecal calprotectin >250 micrograms/g: Experience has shown that elevated faecal calprotectin can be lower on repeat. In undiagnosed patients, with no red flag indicators or increased signs for suspicion of acute severe IBD, with an initial faecal calprotectin >250 micrograms/g patients should be clinically reviewed in primary care. If symptoms are significant or worsening then the GP should refer to gastroenterology urgently, otherwise, repeat the faecal calprotectin.

Sample requirements

• 1 - 5 g faeces collected into a stool collection pot.
• Values below 150 microgrammes per g of faeces normal / IBS
• Values above 150 microgrammes per g of faeces suggest IBD

Advice for Patients

• Patient advice