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Faecal Calprotectin -Quick revision card

non invasive stool test to measure levels of calprotectin Calprotectin is a calcium binding protein which constitutes 60 % of the neutrophil cytosol -it is released during inflammation of the bowel ( neutrophil migration into GI tissue ) Calprotectin is not degraded by gut enzymes – ie the sample can be kept from 5-7 days without any effect on the testing process or result & distribution in stool is homogeneous level of calprotectin is proportional to neutrophil migration through the gut wall and it increases with the degree of inflammation Calprotectin is a better marker of bowel inflammation as other markers as CRP , ESR do not measure bowel inflammation specifically and can be influenced by a number of other non-intestinal conditions

 

The main aim of using this test is to help the clinicians differentiate between Irritable Bowel Syndrome ( IBS ) and Inflammatory Bowel Disease ( IBD ) as the presenting symptoms can be very similar , along with clinical assessment

 

A sensitive test but not specific to one cause , it can also be elevated due to gut infections , diverticulitis , cancer , NSAIDs , coeliac disease , liver cirrhosis , polyps

 

Faecal calprotectin can be readily detected using standard enzyme linked immunosorbent assays
 ( ELISA ) , it has a sensitivity of 93 % and specificity of 96 % in the diagnosis of inflammatory bowel disease in adults NSAID’s should be stopped up to 4 weeks prior to testing

 

When to ask for patient with abdominal pain and looser stools where there is a clinical suspicion of inflammatory bowel disease patient suspected to have IBS using the Rome III criteria ( see chart on IBS ) cancer is not suspected cut-off age varies between regions some quote 18-45 while others as 18-50 ( check local guidance ) patient is less than < 50 can be used for monitoring disease activity , treatment guidance & prediction of disease relapse & post-operative recurrence in IBD

 

When not to request presence of red flags as rectal bleeding , unintentional weight loss , anaemia , rectal mass , abdominal mass , significant family h/o bowel & or ovarian cancer nocturnal symptoms likely infectious diarrhoea screening , surveillance for polyps or bowel cancer high risk ethnic groups ( incl orthodox Jews ) patients > 50 with CIBH children ( lower specificity )

PATIENT INFORMATION

A comprehensive resource from Calprotectin Co UK https://www.calprotectin.co.uk/about-calprotectin/information-for-patients/

Harrogate and Rural District Clinical Commissioning Group of FCP https://northyorkshireccg.nhs.uk/wp-content/uploads/2021/04/faecal-calprotectin-patient-leaflet_final-v4.0_15.11.19.pdf

Lab Tests Online on FCP – a use full complete guide for patients https://labtestsonline.org.uk/tests/calprotectin

REFERENCES

  1. Pathirana, Wpn Ganga W et al. “Faecal Calprotectin.” The Clinical biochemist. Reviews vol. 39,3 (2018): 77-90.Faecal Calprotectin (nih.gov)
  2. Faecal calprotectin diagnostic tests for inflammatory diseases of the bowel (nice.org.uk)
  3. City and Hackney Faecal Calprotectin Pathway *1579260193-0edf64485047c16dd980fe5a3384c718.pdf (gp-website-cdn-prod.s3.amazonaws.com)
  4. Royal United Hospitals Bath – Faecal calprotectin pathway for primary care clinicians *PATH-013_Faecal_Calprotectin_Pathway_for_Primary_Care.pdf (ruh.nhs.uk)
  5. NHS Technology Adoption Centre Faecal Calprotectin testing in primary care *Faecal_Calprotectin_Report_Final_220413.pdf

 

 

 

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