Background Faecal calprotectin (FC) is a cytosolic protein released by neutrophils in inflammation. It is a useful tool in screening children with suspected inflammatory bowel disease (IBD) to discern need for endoscopy, and in monitoring IBD activity after diagnosis.
Aim To evaluate the clinical indications for FC testing and assess the accuracy in detecting IBD in children in a district general hospital (DGH) population.
Method This was a retrospective study conducted at a DGH from January to June 2015. We included all children 0–16 years who had a FC test. Children who had an insufficient sample were subsequently excluded. Data was collected from electronic patient records. Data collected included basic demographics, symptoms,diagnosis and FC results. We also looked at patients referred onward to tertiary gastroenterology including any subsequent endoscopy.
Results 85 patients were identified. In 2 the FC sample was insufficient. There were 43 males and 40 females. The median age was 6 years. Abdominal pain was the most common symptom,seen in 50 children (60%) and loose stool in 44 children (53%). Weight loss was seen in 6 patients (7%) Cow’s milk protein intolerance (CMPI) 18% and constipation (15%) were the common initial diagnosis.
The FC results were as follows
12 patients had a repeat FC test. 8 patients were seen by a paediatric gastroenterologist with 4 requiring endoscopy. 2 were diagnosed with unclassified IBD. Initial FC of IBD patients were >1800mcg/g and 1148 mcg/g. After commencing treatment their FC fell to 658mcg/g and 473mcg/g. In this cohort, with FC >200mcg/g the sensitivity for IBD was 100% and the specificity was 86%. FC >1000mcg/g was also seen in CMPI and campylobacter enteritis.
Conclusion FC is a highly sensitive test for gastrointestinal inflammation in the DGH setting,and a useful rule-out for IBD. The general paediatrician should be aware that the test is not specific and the level can be raised in other forms of gastrointestinal inflammation such as CMPI and gastroenteritis.
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