Fecal Calprotectin Helps Spot Pediatric IBD

By David Douglas
NEW YORK (Reuters Health) Mar 16 - High fecal calprotectin (FC) levels identify children who need endoscopic exams for inflammatory bowel disease (IBD), UK researchers say.
FC is "far superior to commonly utilized blood parameters such as C-reactive protein and white cell count" as a marker of IBD, they reported online February 28th in The American Journal of Gastroenterology.
"This study robustly identifies fecal calprotectin as not only an important biomarker during the treatment of pediatric inflammatory bowel disease but also during the initial investigation of children with suspected disease," Iead author Dr. Paul Henderson told Reuters Health by email.
Dr. Henderson of the University of Edinburgh and colleagues reviewed data on 190 volunteers who had FC testing, including 91 with IBD and 99 controls.
In their own practice, the researchers use a cutoff of 200 mcg/g to define high levels.
In the study, the median FC at diagnosis in the IBD group was 1,265 mcg/g, compared to only 65 mcg/g in controls. In the patient group, values were similar whether with Crohn's disease, ulcerative colitis and unclassified Inflammatory Bowel Disease.
"Our work demonstrates that disease location and type do not influence FC at diagnosis and that FC performs far better than commonly used blood tests," Dr. Henderson said.
Senior author Dr. David C. Wilson added, "(FC) has indeed become our standard of care -- although no single test will be 100% correct in diagnostic terms, it is much superior to any (or a combination of all) commonly used blood 'inflammatory markers.'"
"A negative test is very helpful," he said, "and reduces the number of children in our practice going to invasive testing with GI endoscopy and biopsies; by contrast, a test showing more than 200 mcg/g strengthens our suspicion of Inflammatory Bowel Disease and will expedite further investigation, unless the clinical scenario has markedly improved."
Further studies are now required, but Dr. Wilson pointed out that "because it has become our standard of care, we are not placed to perform the definitive trial with blinded calprotectin usage and evaluation of suspected gut inflammation of children and young people generating robust data on reduction (or not) or need for GI endoscopy and biopsies."
In the meantime, he and his colleagues predict, someday "the routine use of FC in the pediatric setting should significantly enhance our ability to more accurately screen children for Inflammatory Bowel Disease."