Faecal Calprotectin Dr Rob Palmer CCG Gastro Lead

Faecal Calprotectin Dr Rob Palmer – CCG Gastro Lead

IBS or IBD? • • IBS affects 10 20% of adult population Symptoms can be similar to those of IBD (esp IBS D) Blood tests not always conclusive ### Patients often end up having colonoscopy Rome III Criteria for IBS: Basic criteria Recurrent abdominal pain or discomfort at • Uncomfortable least 3 days per month in the last 3 months, associated with 2 or more of the • Costly following: • • • Improvement with defecation Onset associated with a change in frequency of stool Onset associated with a change in form (appearance) of stool

Faecal calprotectin • A protein released from phago cytesand epithelial cells during inflammation • Resistant to intestinal degrada tion and is distributed throughout the stool • Can be detected readily using standard ELISAs • Sensitivity of 93% and a specificity of 96% for the diagnosis of IBD Faecal calprotectin should be considered in patients presenting with abdominal pain and looser stools, where there is a clinical suspicion of inflammatory pathology

Don’t use calprotectin if • A clear clinical diagnosis of IBS – only when suspicion of IBD • Likely infectious diarrhoea (false positive) • New onset of GI symptoms in older patients further investigations likely to be necessary • Children (lower specificity)

• May reduce costs and unnecessary patient discomfort / risk • The cost of the test (at Homerton hospital laboratory) = £ 14. 11 • The current tariff for a colonoscopy (at Homerton) = £ 545 £ 650