1. Dr Rob Palmer – CCG Gastro Lead
Faecal Calprotectin
Dr Rob Palmer – CCG Gastro Lead

2. 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

3. 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

4. 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)

5. 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