The Use of Faecal Calprotectin in
Primary Care
Ian Arnott
Consultant Gastroenterologist
Western General Hospital
Edinburgh
MH 30 years female
 3/12 history of abdominal pain
 Right sided
 Constipation – BOx1/week
 No weight loss, appetite unchanged
 No past medical history
 Non-smoker
Investigations
 Full blood count
 Hb 127
 WCC 7.9
 Plt 293
 USS normal
Impression
 “... I think the most likely diagnosis is constipation
predominant irritable bowel syndrome. I would suggest a
trial of laxatives...”
 Ian Arnott
 BUT
 Faecal calprotectin >2500g/g
Colonoscopy
Difficult to differentiate organic from
functional symptoms
 IBD more common
 Up to 2% of population in high areas
Delay in diagnosis of IBD is important
Colonoscopy
• Key diagnostic tool
– Colorectal cancer
– Inflammatory bowel disease
– Etc etc...
• BUT patients with IBS do not always need this
– Unpleasant
– Reinforce doubt about diagnosis
– Resource intensive
Faecal calprotectin
Faecal Calprotectin: IBD v IBS
Henderson et al. AJG 2014
Organic v IBS
Organic v IBS
 Cut off <50µg/g
 Sensitivity 99%
 Specificity 74%
 Cut off <100µg/g
 Sensitivity 94%
 Specificity 82%
Durham Dales Primary Care Pilot
 6.3% prevalence of IBD
 25% of presenting patients are referred
 FC testing saved 129 referrals
 Greater satisfaction for patients
 Approval from GPs
Gastroenterology in Lothian
 1 in 10 consultations in primary care
 Referrals in Lothian July 13 – June 14
 Total 7898
 WGH 3379
 RIE 3325
 St John’s 1126
NICE Guidance
 Recommended in children and adults
 IBD v IBS in those with lower GI symptoms,
if:
 Cancer not suspected
 Appropriate Quality assurance
Cost Effectiveness
 NICE estimates – most conservative
 FC assay costs £22
 Colonoscopy £741
 Compared with current practice FC saves
 £82 – 240 per patient seen
FC Experience in Lothian
Kennedy NA et al, JCC 2014
Faecal calprotectin: Results
 Functional v other GI conditions
 Sensitivity 89%
 Negative predictive value 93%
 Functional v IBD
 Sensitivity 99%
 NPV 100%
FC together with Alarm Symptoms
Calprotectin: Who to test
FC algorithm
Lothian Algorithm - Pilot
Age less than 50?
no
Consider referral as per
current guidance
yes
Alarm symptoms?
Referral for urgent
investigation
Faecal calprotectin,
Stool culture, Coeliac
screen & FBC
Referral for D2 bx or
other investigation
FC 50 - 150
FC<50
FC >150
Repeat calprotectin in 4
– 6 weeks. Functional
diagnosis likely
Functional diagnosis
Referral for
investigation
Conclusions
 Faecal calprotectin can effectively differentiate between IBS




and organic GI conditions
Simple to assay
Helps select patients for referral or investigation
Cost effective
Pilot in Lothian planned – please take part!
[email protected]