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Calprotectin has several characteristics of an ideal test: simple, non-invasive and low cost. These features allow for serial monitoring of the disease as well as success or failure of treatment. It is stable in faeces for several days. Calprotectin is an abundant neutrophil protein found in both plasma and stool that is markedly elevated in infectious and inflammatory conditions, including inflammatory bowel disease (IBD). There is therefore a role for Calprotectin as a faecal marker for inflammatory bowel disease. It allows for differentiation between organic diarrhoea and functional diarrhoea. Chronic diarrhoea is a relatively common condition in the western world but despite its frequency, it often poses a diagnostic challenge. In gastroenterological practice there is a need for a simple test to assist in the selection of patients with prolonged diarrhoea and/or other non-specific gastrointestinal symptoms for complex diagnostic procedures.
A systematic review of published literature regarding faecal calprotectin to evaluate its potential as a non-invasive marker of neutrophilic intestinal inflammation shows that reference ranges for faecal calprotectin have been established in healthy adults and children, and elevated concentrations of faecal calprotectin have been demonstrated in numerous studies of patients with IBD.
Faecal calprotectin correlates well with histological inflammation as detected by colonoscopy with biopsies, and has been shown successfully to predict relapses and detect pouchitis in patients with IBD. Faecal calprotectin has been shown to consistently differentiate IBD from irritable bowel syndrome because it has excellent negative predictive value in ruling out IBD in undiagnosed, symptomatic patients. Faecal calprotectin also may be useful in determining whether clinical symptoms in patients with known IBD are caused by disease flares or non-inflammatory complications/underlying irritable bowel syndrome and in providing objective evidence of response to treatment.
Although more studies are needed to define fully the role of faecal calprotectin, convincing studies and growing clinical experience point to an expanded role in the diagnosis and management of IBD.
Inflamm Bowel Disease 2006 Jun;12(6):524-34.
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