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
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