scholarly journals Guidance on the interpretation of faecal calprotectin levels in children

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0246091
Author(s):  
Martina Orfei ◽  
Marco Gasparetto ◽  
Kai O. Hensel ◽  
Florian Zellweger ◽  
Robert B. Heuschkel ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Catchment Area ◽  
Gastrointestinal Symptoms ◽  
Reference Value ◽  
Cost Effective ◽  
Diagnostic Value ◽  
Older Children ◽  
Faecal Calprotectin ◽  
Blood Tests ◽  
Inflammatory Bowel

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 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. 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 μg/g, 15% were ≥ 250 μg/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 μg/g (or 8.6% with an FCP of < 600 μg/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 μg/g) was the sole reason for being referred for suspected IBD did not have IBD. Conclusion Children with an FCP < 600 μg/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.

scholarly journals P480 Assessing primary response to biologic therapy in Inflammatory Bowel Disease - ‘the when and the how?’

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S470-S470
Author(s):  
A C Moore ◽  
S Peake
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Biological Therapy ◽  
Biologic Therapy ◽  
Clinical Symptoms ◽  
Primary Response ◽  
Mucosal Inflammation ◽  
Faecal Calprotectin ◽  
Blood Tests ◽  
Inflammatory Bowel

Abstract Background ECCO guidelines state that patients started on biologic therapy for Inflammatory Bowel Disease (IBD) should be reviewed between week 10 and 16 depending on the biologic used and response assessed using predefined objective criteria. The study aim was to ascertain, the time point, and by which methods patients with IBD are being assessed for primary response. Methods A retrospective chart review was conducted of 50 consecutive patients with IBD who had been started on biological therapy between October 2018 and June 2019 at a tertiary referral university teaching hospital in London, UK. Results Patients were started on 5 biologics; infliximab (20 patients), adalimumab (11 patients), vedolizumab (6 patients), ustekinumab (9 patients) and tofacitinib (4 patients). Twenty two patients had Ulcerative Colitis and 28 patients had Crohn’s Disease. All 50 patients were still receiving biological therapy at the time of their first assessment in a consultant led IBD clinic. On average, patients were assessed at week 13 for primary response. Figure 1 outlines the time to assessment of disease response, according to the biologic used. The most frequently used methods were clinical symptoms (49 patients, 98%) and blood tests (47 patients, 94%). Disease activity scores were rarely documented. Other methods of disease assessment were faecal calprotectin (13 patients, 26%), ileocolonoscopy (11 patients, 22%) and radiological studies (2 patients, 4%). Only 19 patients (38%) had either a faecal calprotectin or a colonoscopy ordered at their appointment. Thirteen patients (26%) had undergone an endoscopic assessment of their disease when the data was analysed in December 2019. Conclusion Patients are being assessed in a timely fashion for primary response to biological therapy, in line with current ECCO guidelines. Clinical symptoms and blood tests are being heavily relied on to assess for primary response to therapy. Patient-reported symptoms do not correlate well with mucosal inflammation in IBD1. Faecal Calprotectin, as a surrogate marker of mucosal inflammation, and colonoscopy are being underused. Potential reasons for the low rates of colonoscopy may include patient’s wishes and lack of endoscopy capacity. The importance of a mucosal healing assessment is imperative to be able to optimise treatment appropriately and improve long-term outcomes for our patients. Reference

Primary care faecal calprotectin testing in children with suspected inflammatory bowel disease: a diagnostic accuracy study

2020 ◽  
Vol 105 (10) ◽  
pp. 957-963
Author(s):  
Gareth J Walker ◽  
Neil Chanchlani ◽  
Amanda Thomas ◽  
Simeng Lin ◽  
Lucy Moore ◽  
...  
Keyword(s):  
Primary Care ◽  
Inflammatory Bowel Disease ◽  
Diagnostic Accuracy ◽  
Bowel Disease ◽  
Predictive Value ◽  
Secondary Care ◽  
Gastrointestinal Symptoms ◽  
Healthcare Utilisation ◽  
Faecal Calprotectin ◽  
Inflammatory Bowel

ObjectiveTo determine the diagnostic accuracy of calprotectin to diagnose inflammatory bowel disease (IBD) in children in whom general practitioners (GPs) suspected IBD.DesignProspective observational cohort study of a new calprotectin-based primary care referral pathway.Setting48 GP practices and gastroenterology secondary care services at the Royal Devon and Exeter NHS Foundation Trust in the South-West of England, UK.Patients195 children aged between 4 and 18 years referred on the pathway between January 2014 and August 2017 for investigation of gastrointestinal symptoms were included.InterventionsPrimary-care-driven faecal calprotectin testing. Primary and secondary care records over 12 months from the point of calprotectin testing were used as the reference standard.Main outcome measuresDiagnostic accuracy of calprotectin testing to detect IBD.Results7% (13/195) tested patients were diagnosed with IBD. Using our prespecified cut-off of 100 µg/g, calprotectin had a diagnostic accuracy of 91% (95% CI 86% to 95%) with a sensitivity for distinguishing IBD from non-IBD of 100% (95% CI 75% to 100%), a specificity of 91% (95% CI 85% to 94%), a positive predictive value of 43% (95% CI 25% to 63%) and a negative predictive value of 100% (95% CI 98% to 100%). Calprotectin testing had no effect on the time to diagnosis, but a negative test contributed to saved referrals and was associated with fewer diagnostic tests in secondary care.ConclusionsCalprotectin testing of children with suspected IBD in primary care accurately distinguishes IBD from a functional gut disorder, reduces secondary care referrals and associated diagnostic healthcare utilisation.

Effect of faecal calprotectin assay variability on the management of inflammatory bowel disease and potential role of faecal S100A12

2017 ◽  
Vol 70 (12) ◽  
pp. 1049-1056 ◽  
Author(s):  
Simon John Whitehead ◽  
Clare Ford ◽  
Rousseau Mariano Gama ◽  
Ala Ali ◽  
Brian McKaig ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Diagnostic Accuracy ◽  
Bowel Disease ◽  
Potential Role ◽  
Diagnostic Value ◽  
Blood Biomarkers ◽  
Faecal Calprotectin ◽  
Inflammatory Bowel ◽  
Irritable Bowel

AimsTo prospectively evaluate whether between-assay variability of different faecal calprotectin (f-Cp) assays influences diagnostic accuracy for inflammatory bowel disease (IBD) in a cohort of patients with confirmed IBD and irritable bowel syndrome (IBS). To also evaluate the diagnostic accuracy of faecal S100A12 (f-S100A12) against f-Cp in the same patient cohort and assess whether f-S100A12 offers additional diagnostic value.MethodsF-Cp using four commercially available f-Cp assays, f-S100A12 and blood biomarkers were measured in patients, recruited from the local IBD clinic, who had established IBS or active ulcerative colitis (UC) and Crohn’s disease (CD). Diagnostic sensitivities and specificities for each assay and biomarker were calculated and compared.ResultsMedian f-Cp levels in all assays were significantly higher in UC (347–884 µg/g; n=28) and CD (377–838 µg/g; n=15) compared with IBS (6–27 µg/g; n=17). Sensitivities and specificities at 50 µg/g were 94%–100% and 82%–100%, respectively. Median f-S100A12 levels were significantly higher in UC (81.0 µg/g; IQR 38.3–159.8) and CD (47.2 µg/g; IQR 5.3–108.9) compared with IBS (0.7 µg/g; IQR 0.5–0.8). At 2.8 µg/g, f-S100A12 had a sensitivity of 97% and specificity of 94%. The blood biomarkers demonstrated sensitivities and specificities of 44%–63% and 80%–92%, respectively.ConclusionsThe diagnostic sensitivity of the calprotectin assays was similar despite inter-kit variability in absolute values. There is a need for f-Cp assay standardisation, but in its absence assay-specific cut-off values may optimise their diagnostic performance. F-S100A12 demonstrated comparable sensitivity and specificity to f-Cp and although a research tool at present, may have a future role to play in the diagnosis and management of these patients.

scholarly journals Cost-effectiveness of faecal calprotectin used in primary care in the diagnosis of inflammatory bowel disease

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e027043 ◽  
Author(s):  
Wei Zhang ◽  
Chiew Hsia Wong ◽  
Mallory Chavannes ◽  
Tima Mohammadi ◽  
Greg Rosenfeld
Keyword(s):  
Primary Care ◽  
Inflammatory Bowel Disease ◽  
Cost Effectiveness ◽  
Bowel Disease ◽  
Blood Test ◽  
Gastrointestinal Symptoms ◽  
Cost Effective ◽  
Adult Patients ◽  
Standard Practice ◽  
Inflammatory Bowel

ObjectiveInflammatory bowel disease (IBD) is a chronic, autoimmune, gastrointestinal disorder. Canada has one of the highest prevalence and incidence rates of IBD in the world. Diagnosis is challenging due to the similarity of symptoms to functional gastrointestinal disorders. Faecalcalprotectin (FC) is a biomarker for active mucosal inflammation and has proven effective in the diagnosis of IBD. Our study objective was to assess the cost-effectiveness of adding an FC test compared with standard practice (blood test) in primary care among adult patients presenting with gastrointestinal symptoms.DesignWe constructed a decision analytic tree with a 1-year time horizon. The cut-off level of 100 µg/g was used for FC testing. Probabilistic analyses were conducted for the base case and all scenarios.SettingCanadian health sector perspective.PopulationA hypothetical cohort of adult patients presenting with gastrointestinal symptoms in the primary care setting.InterventionsFC test compared with blood test.Main outcome measuresCosts, quality-adjusted life years (QALYs), incremental cost-effectiveness ratio (ICER) of FC test expressed as cost per QALY gained compared with blood test and time to IBD diagnosis.ResultsFC testing is expected to cost more ($C295.1 vs $C273.9) than standard practice but yield little higher QALY (0.751vs0.750). The ICER of FC test was $C20 323 per QALY. Probabilistic analysis demonstrated that at a willingness-to-pay threshold of $C50 000 per QALY, there was 81.3% probability of FC test being cost-effective. The use of FC test in primary care reduced the time to IBD diagnosis by 40.0 days (95% CI 16.3 to 65.3 days), compared with blood testing alone.ConclusionsBased on this analysis of short-term outcomes, screening adult patients in primary care using FC test at a cut-off level of 100 µg/g is expected to be cost-effective in Canada.

scholarly journals Sphingolipid Analysis Indicate Lactosylceramide as a Potential Biomarker of Inflammatory Bowel Disease in Children

Biomolecules ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. 1083
Author(s):  
Aleksandra Filimoniuk ◽  
Agnieszka Blachnio-Zabielska ◽  
Monika Imierska ◽  
Dariusz Marek Lebensztejn ◽  
Urszula Daniluk
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
High Performance ◽  
Area Under The Curve ◽  
Study Groups ◽  
Diagnostic Value ◽  
Serum Samples ◽  
Specificity And Sensitivity ◽  
Potential Biomarker ◽  
Inflammatory Bowel

An altered ceramide composition in patients with inflammatory bowel disease (IBD) has been reported recently. The aim of this study was to evaluate the concentrations of sphingolipids in the serum of treatment-naive children with newly diagnosed IBD and to determine the diagnostic value of the tested lipids in pediatric IBD. The concentrations of sphingolipids in serum samples were evaluated using a quantitative method, an ultra-high-performance liquid chromatography-tandem mass spectrometry in children with Crohn’s disease (CD) (n=34), ulcerative colitis (UC) (n = 39), and controls (Ctr) (n = 24). Among the study groups, the most significant differences in concentrations were noted for C16:0-LacCer, especially in children with CD compared to Ctr or even to UC. Additionally, the relevant increase in C20:0-Cer and C18:1-Cer concentrations were detected in both IBD groups compared to Ctr. The enhanced C24:0-Cer level was observed only in UC, while C18:0-Cer only in the CD group. The highest area under the curve (AUC), specificity, and sensitivity were determined for C16:0-LacCer in CD diagnosis. Our results suggest that the serum LacC16-Cer may be a potential biomarker that distinguishes children with IBD from healthy controls and differentiates IBD subtypes. In addition, C20:0-Cer and C18:0-Cer levels also seem to be closely connected with IBD.

scholarly journals Lactobacillus Reuteri DSM 17938 (Limosilactobacillus reuteri) in Diarrhea and Constipation: Two Sides of the Same Coin?

Medicina ◽  
2021 ◽  
Vol 57 (7) ◽  
pp. 643
Author(s):  
Angela Saviano ◽  
Mattia Brigida ◽  
Alessio Migneco ◽  
Gayani Gunawardena ◽  
Christian Zanza ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Emergency Department ◽  
Abdominal Pain ◽  
Human Health ◽  
Bowel Disease ◽  
Chronic Constipation ◽  
Lactobacillus Reuteri ◽  
Current Knowledge ◽  
Gastrointestinal Symptoms ◽  
Inflammatory Bowel

Background and Objectives: Lactobacillus reuteri DSM 17938 (L. reuteri) is a probiotic that can colonize different human body sites, including primarily the gastrointestinal tract, but also the urinary tract, the skin, and breast milk. Literature data showed that the administration of L. reuteri can be beneficial to human health. The aim of this review was to summarize current knowledge on the role of L. reuteri in the management of gastrointestinal symptoms, abdominal pain, diarrhea and constipation, both in adults and children, which are frequent reasons for admission to the emergency department (ED), in order to promote the best selection of probiotic type in the treatment of these uncomfortable and common symptoms. Materials and Methods: We searched articles on PubMed® from January 2011 to January 2021. Results: Numerous clinical studies suggested that L. reuteri may be helpful in modulating gut microbiota, eliminating infections, and attenuating the gastrointestinal symptoms of enteric colitis, antibiotic-associated diarrhea (also related to the treatment of Helicobacter pylori (HP) infection), irritable bowel syndrome, inflammatory bowel disease, and chronic constipation. In both children and in adults, L. reuteri shortens the duration of acute infectious diarrhea and improves abdominal pain in patients with colitis or inflammatory bowel disease. It can ameliorate dyspepsia and symptoms of gastritis in patients with HP infection. Moreover, it improves gut motility and chronic constipation. Conclusion: Currently, probiotics are widely used to prevent and treat numerous gastrointestinal disorders. In our opinion, L. reuteri meets all the requirements to be considered a safe, well-tolerated, and efficacious probiotic that is able to contribute to the beneficial effects on gut-human health, preventing and treating many gastrointestinal symptoms, and speeding up the recovery and discharge of patients accessing the emergency department.

scholarly journals Impact of COVID-19 on the diagnosis, assessment and management of children with inflammatory bowel disease in the UK: implications for practice

2020 ◽  
Vol 4 (1) ◽  
pp. e000786
Author(s):  
Abbie Maclean ◽  
James J Ashton ◽  
Vikki Garrick ◽  
R Mark Beattie ◽  
Richard Hansen
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Delayed Diagnosis ◽  
High Standard ◽  
Current Evidence ◽  
Faecal Calprotectin ◽  
Paediatric Patients ◽  
Inflammatory Bowel ◽  
Working Practices ◽  
The Impact

The assessment and management of patients with known, or suspected, paediatric inflammatory bowel disease (PIBD) has been hugely impacted by the COVID-19 pandemic. Although current evidence of the impact of COVID-19 infection in children with PIBD has provided a degree of reassurance, there continues to be the potential for significant secondary harm caused by the changes to normal working practices and reorganisation of services.Disruption to the normal running of diagnostic and assessment procedures, such as endoscopy, has resulted in the potential for secondary harm to patients including delayed diagnosis and delay in treatment. Difficult management decisions have been made in order to minimise COVID-19 risk for this patient group while avoiding harm. Initiating and continuing immunosuppressive and biological therapies in the absence of normal surveillance and diagnostic procedures have posed many challenges.Despite this, changes to working practices, including virtual clinic appointments, home faecal calprotectin testing kits and continued intensive support from clinical nurse specialists and other members of the multidisciplinary team, have resulted in patients still receiving a high standard of care, with those who require face-to-face intervention being highlighted.These changes have the potential to revolutionise the way in which patients receive routine care in the future, with the inclusion of telemedicine increasingly attractive for stable patients. There is also the need to use lessons learnt from this pandemic to plan for a possible second wave, or future pandemics as well as implementing some permanent changes to normal working practices.In this review, we describe the diagnosis, management and direct impact of COVID-19 in paediatric patients with IBD. We summarise the guidance and describe the implemented changes, evolving evidence and the implications of this virus on paediatric patients with IBD and working practices.

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