Welcome to PracticeUpdate! We hope you are enjoying access to a selection of our top-read and most recent articles. Please register today for a free account and gain full access to all of our expert-selected content.
Already Have An Account? Log in Now
Diagnostic Performance of Faecal Calprotectin Level in Distinguishing Inflammatory Bowel Disease From Irritable Bowel Syndrome in Adults
TAKE-HOME MESSAGE
- This systematic review and meta-analysis pooled data from 17 diagnostic studies that assessed the diagnostic performance of faecal calprotectin level measurement in distinguishing IBD from IBS. Using the data, the investigators estimated a pooled sensitivity of 85.8% and specificity of 91.7%, which, for an IBD prevalence of 1%, would translate to negative and positive predictive values of 99.8% and 9.0%, respectively. The performance of faecal calprotectin level measurement did not significantly vary in many subgroup analyses, including study design, patients with non-active IBD, and Rome criteria used.
- Despite good sensitivity and specificity, the use of faecal calprotectin level measurement to distinguish IBD from IBS is primarily highlighted by its negative predictive value.
abstract
This abstract is available on the publisher's site.
Access this abstract nowBACKGROUND
Symptoms of inflammatory bowel disease (IBD) often overlap with those of irritable bowel syndrome (IBS).
AIM
To evaluate the diagnostic performance of faecal calprotectin in distinguishing patients with IBD from those with IBS METHODS: We searched MEDLINE, Embase, Scopus, and Cochrane Library databases up to 1 January 2023. Studies were included if they assessed the diagnostic performance of faecal calprotectin in distinguishing IBD from IBS (defined according to the Rome criteria) using colonoscopy with histology or radiology as reference standard in adults. We calculated summary sensitivity and specificity and their 95% confidence intervals (CI) using a random-effect bivariate model. The risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies II.
RESULTS
We included 17 studies with a total of 1956 patients. The summary sensitivity was 85.8% (95% CI: 78.3-91), and the specificity was 91.7% (95% CI: 84.5-95.7). At a prevalence of IBD of 1%, the negative predictive value was 99.8%, while the positive predictive value was only 9%. Subgroup analyses showed a higher sensitivity in Western than in Eastern countries (88% vs 73%) and at a cut-off of ≤50 μg/g than at >50 μg/g (87% vs. 79%), with similar estimates of specificity. All studies were at "high" or "unclear" risk of bias.
CONCLUSIONS
Faecal calprotectin is a reliable test in distinguishing patients with IBD from those with IBS. Faecal calprotectin seems to have a better sensitivity in Western countries and at a cut-off of ≤50 μg/g.
Additional Info
Disclosure statements are available on the authors' profiles:
Systematic review with meta-analysis: Diagnostic performance of faecal calprotectin in distinguishing inflammatory bowel disease from irritable bowel syndrome in adults
Aliment. Pharmacol. Ther. 2023 Oct 12;[EPub Ahead of Print], E Dajti, L Frazzoni, V Iascone, M Secco, A Vestito, L Fuccio, LH Eusebi, P Fusaroli, F Rizzello, C Calabrese, P Gionchetti, F Bazzoli, RM ZagariFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Fecal calprotectin can rule out IBD
Calprotectin is a protein that binds to calcium, which is produced when neutrophils are activated as part of an inflammatory process to protect the body (cal: calcium; protectin: protein that protects). It can be found in saliva, serum, spinal fluid, and stool. Its use can save significant cost and burden by avoiding unnecessary colonoscopy when wanting to rule out inflammatory bowel disease (IBD) in patients with irritable bowel syndrome (IBS). However, is fecal calprotectin reliable?
This meta-analysis included 17 studies of 1956 patients with IBS evaluated with fecal calprotectin. The negative predictive value of the test was high at 99.8%, but the positive predictive value was low at just 9%. This finding supports the use of calprotectin in ruling out IBD. For a result less than 50 ug/g, only 1 out of 100 patients with a negative test will have IBD. However, when the test comes back positive at greater than 50 ug/g, there is still a low certainty of the patient having IBD. Be sure to manage these expectations appropriately to reduce fear in patients with a positive test.
Elevated levels were more commonly associated with Crohn’s disease compared with ulcerative colitis.
Fecal calprotectin is an inexpensive test that runs at about $20 in the US. It is a measure of gut inflammation, which can help rule out IBD. As with any test, it is not absolute. However, it is a useful test in the evaluation of patients with IBS to make sure these diverse symptoms are not associated with underlying inflammatory bowel disease.