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
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
INTRODUCTION
 SIMPLE, NON-INVASIVE TESTS ARE NEEDED
 FECAL BIOMARKER TESTS HAVE RECEIVED MUCH INTEREST
E.G. CALPROTECTIN AND IFOB TESTS
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).
…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
… IN IBD ACTIVITY
• IBD ACTIVITY: SYMPTOMS, CLINICAL FINDING AND ENDOSCOPY.
• CALPROTECTIN BETTER THAN CRP, WBC OF BLOOD, CLINICAL ACTIVITY SCORES
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
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.
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.
FECAL CALPROTECTIN, MMP-9, AND HUMAN BETADEFENSIN-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.
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.
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, …..
REFERENCE
1. PMID: 24077667
2. PMID: 23883663