Faecal Calprotectin

 

Please see link to IBS page here: 
https://rms.cornwall.nhs.uk/rms/primary_care_clinical_referral_criteria/rms/primary_care_clinical_referral_criteria/gastro/ibs 

Please see link to IBD page here:
https://rms.cornwall.nhs.uk/primary_care_clinical_referral_criteria/rms/primary_care_clinical_referral_criteria/gastro/inflammatory_bowel_disease

WHEN TO USE FAECAL CALPROTECTIN TEST:

Sometimes the clinical scenario is pretty obviously IBS – intermittent disturbance of bowel habit with pain and bloating, onset at a younger age, worse after food and with stress etc. 

Sometimes it’s obviously IBD, bloody diarrhoea, weight loss, raised inflammatory markers / platelet count.

In these situations, you don’t need to use a faecal calprotectin

 

BUT IBS and IBD can share clinical features. For example the case might look like IBS but there are some atypical features e.g pain at night or a bit of blood...

...that’s when to send a faecal calprotectin.  

 

Generally speaking a low calprotectin indicates IBS and a raised level suggests possible IBD

Calprotectin is a protein released from intestinal mucosal neutrophils during inflammation and can be detected in the stool – the higher the level, the more the inflammatory load. It can be raised for reasons other than IBD

 

WHO SHOULD I REQUEST A FAECAL CALPROTECTIN ON?

Faecal calprotectin should be considered in:

• Patients aged 16-60 years
• Patients who present with lower gastrointestinal symptoms in whom you suspect IBS or IBD and there is diagnostic uncertainty

 

WHEN DO I REQUEST A FAECAL CALPROTECTIN?

Faecal calprotectin should be requested alongside or after any other tests you consider to be clinically appropriate such as:

• FBC, urea and electrolytes, C-reactive protein, LFT, bone
• Coeliac screen
• Thyroid function
• Stool culture and C. difficile request

Don’t use it if you suspect cancer – see qFIT LINK HERE

 

RESULTS

LOW ( < 100mcg/g )– IBS 98% certainty

• Of the 2% the diagnosis is usually benign and non-inflammatory in nature e.g. small bowel bacterial overgrowth or microscopic colitis. IBD is very rare in this group
• Be open-minded to other diagnoses if the clinical situation changes
• Consider urological / gynae pathology
• Treat as IBS LINK HERE- if symptoms continue to be bothersome risk stratify thus:
• Age < 50 AND FC < 50 then IBS ALMOST CERTAIN (>99%) so continue IBS approach
• Age >= 50 OR if FC 50-100 then consider referral to gastro – IBS 81% likely

HIGH ( > 100mcg/g)– repeat the test within two weeks

• We do this because transient false positives can occur e.g. NSAIDs [please stop], infectious diarrhoea

 

NB - f you have a high clinical suspicion of inflammatory bowel/ and very raised calprotectin such that you do not feel appropriate to delay to await the second one, please make this very clear in the opening clinical detail.  Referral without this information and with 1 calprotectin will be returned to await second calprotectin as in the guidance 

 

 

REPEAT TEST RESULT

LOW  (< 100 mcg/g)- IBS 98% certainty – as above

MEDIUM (100-250 mcg/g)– IBD 12% likely

• Routine referral to gastro, the patient will probably be offered a colonoscopy

HIGH (> 250mcg/g)- IBD > 46% likely

• URGENT referral to gastroenterology

 

 

 

 

Date of review                          03/03/2022

Date of next review                  03/03/2023

RMS review GP                       Dr Madeleine Attridge

Authors                                    Dr J Huddy GPSI Gastro

            Dr J Beckly Consultant Gastroenterologist RCH

                            

Contributors                  With thanks to Dr. James Turvill, Consultant Gastroenterologist

York Teaching Hospital NHS Foundation Trust