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 Uncomfortable Costly Rome III Criteria for IBS: Basic criteria Recurrent abdominal pain or discomfort at least 3 days per month in the last 3 months, associated with 2 or more of the following: Improvement with defecation Onset associated with a change in frequency of stool Onset associated with a change in form (appearance) of stool Sensitivity of CRP in dx Crohns

Faecal calprotectin A protein released from phago­cytes and epithelial cells during inflammation Resistant to intestinal degrada­tion 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