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Guidance on the interpretation of faecal calprotectin levels in children.


ABSTRACT:

Background

Faecal calprotectin (FCP) is a powerful tool to predict inflammatory bowel disease (IBD) in patients with gastrointestinal symptoms. In the paediatric patient population, the reference value of < 50 ?g/g and the influence of age on FCP levels result in a high number of redundant investigations and specialist referrals. We assessed paediatric FCP levels, their diagnostic value and corresponding referral pathways from primary and secondary care.

Methods

We analysed two cohorts from a precisely defined catchment area: one consisted of all FCPs measured in this area (n = 2788). The second cohort-a subset of the first cohort-consisted of FCP values and corresponding clinical data from children who were referred for possible IBD to our department (n = 373).

Results

In the first cohort, 47% of FCP levels were > 50 ?g/g, 15% were ? 250 ?g/g. Children < 1y had significantly (p < 0.001) higher FCP than older children. In the second cohort, 6.7% of children with an FCP of < 250 ?g/g (or 8.6% with an FCP of < 600 ?g/g) had IBD-all featured symptoms suggestive of IBD (e.g. bloody diarrhoea, nocturnal abdominal pain, weight loss) or abnormal blood tests. 76% of patients in whom raised FCP (> 50 ?g/g) was the sole reason for being referred for suspected IBD did not have IBD.

Conclusion

Children with an FCP < 600 ?g/g and without matching symptoms suggestive of IBD are unlikely to have IBD. A higher FCP reference value may provide cost-effective improvement that could avoid redundant investigations and specialist referrals. A guideline for specialist referrals is proposed.

SUBMITTER: Orfei M 

PROVIDER: S-EPMC7877663 | biostudies-literature | 2021

REPOSITORIES: biostudies-literature

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Publications

Guidance on the interpretation of faecal calprotectin levels in children.

Orfei Martina M   Gasparetto Marco M   Hensel Kai O KO   Zellweger Florian F   Heuschkel Robert B RB   Zilbauer Matthias M  

PloS one 20210211 2


<h4>Background</h4>Faecal calprotectin (FCP) is a powerful tool to predict inflammatory bowel disease (IBD) in patients with gastrointestinal symptoms. In the paediatric patient population, the reference value of < 50 μg/g and the influence of age on FCP levels result in a high number of redundant investigations and specialist referrals. We assessed paediatric FCP levels, their diagnostic value and corresponding referral pathways from primary and secondary care.<h4>Methods</h4>We analysed two co  ...[more]

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