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Fecal calprotectin

Fecal calprotectin. DR Amin Eftekhari. introduction. Lower abdominal complaints are common in primary care Organic bowel disease (OBD) is rare: Colorectal cancer, advanced adenomatous polyps Inflammatory bowel disease (IBD) Symptoms of OBD overlap with benign and functional

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Fecal calprotectin

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  1. Fecal calprotectin DR Amin Eftekhari

  2. introduction • Lower abdominal complaints are common in primary care • Organic bowel disease (OBD) is rare: • Colorectal cancer, advanced adenomatous polyps • Inflammatory bowel disease (IBD) • Symptoms of OBD overlap with benign and functional bowel disorders • Diagnostic challenge for the general practitioner (GP) • Fear of missing OBD results in many referrals for colonoscopy • Colonoscopy is invasive, costly and a scarce resource

  3. introduction • Simple, non-invasive tests are needed • Fecal biomarker tests have received much interest • E.g. calprotectin and iFOB tests

  4. cALPROTECTIN • 36 kDa Ca and Zn binding protein mainly derivied from Neutrophies • Its belongs to S100 proteins • Antimicrobial activity by competing for Zn and by inhibiting of Zn depending enzymes • Elevated concentration of it can be measerd in plasma, synovial fluid, urine, liquor, saliva and fecus when an inflammation process with recruitment of neutrophils is ongoing. • Ecxellent stability in feces at roon temprature for as long as a week. • The units were changed from mg/l to µg/g (feces).

  5. …IN INFLAMMATORY BOWEL DISEASE • IBD V/S IBS: sensitivity 95%, specificity: 91% • Superior to serological markers such as CRP, ESR, ASCA, p-ANCA. • False negative test: delay diagnosis in 6% of adults and 8% of children. • False positive: acute gastrointestinal infection and NSAID induced entropathy • S100/A12: more specific and sensitive than calprotectin

  6. … in ibd activity • IBD activity: symptoms, clinical finding and endoscopy. • Calprotectin better than CRP, WBC of blood, clinical activity scores

  7. Correlation with ibd localization • Higher FCC in colonic than ileal crohn s disease patients also in recent studies it is not approved. • FCC can not be used as a marker of localization of disease

  8. Response to therapy • Available data appear still quite weak to support the role of fecal calprotectin as a promising surrogate marker of mucosal healing reducing the need of endoscopic examination.

  9. Fcc in ibd patients undergoing bowel resection • Extensive ileocolic resection: diarrhea , bloating, pain without of recurrence of disease. • Recurrence of active disease: pain, diarrhea, fever rectal bleeding. • FCC is useful to avoid multiple endoscopic examination however more studies is required.

  10. Fecal calprotectin, MMP-9, and human beta-defensin-2 levels in pediatric ibd.(2013)1 ….measured with ELISA in 110 pediatric patients with IBD (Crohn's disease, n = 68; ulcerative colitis (UC), n = 27; unclassified, n = 15; median age, 14). Calprotectin was the best fecal marker in pediatric IBD. MMP-9 showed almost comparable performance in UC. Fecal HBD-2 did not bring information to the disease characteristics of pediatric IBD patients.

  11. Effectiveness and Cost-effectiveness of Measuring Fecal Calprotectin in Diagnosis of Inflammatory Bowel Disease in Adults and Children.2 • compare the cost-effectiveness of measuring FC before endoscopy examination with that of direct endoscopic evaluation alone. • If endoscopic biopsy analysis remained the standard for diagnosis, direct endoscopic evaluation would cost an additional $18,955 in adults and $6250 in children to avoid 1 false-negative result from FC screening. • Screening adults and children to measure fecal levels of calprotectin is effective and cost-effective in identifying those with IBD.

  12. Conclusions • Good diagnostic precision for separating organic and functional intestinal disease. (avoid unnecessary endoscopy). • A marker of neutrophilic intestinal inflammation, not organic intestinal disease. • Better correlate with IBD activity rather than relapse, extent, …..

  13. reference • PMID: 24077667 • PMID: 23883663

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