Faecal Calprotectin

Recently an overview of Dr Tibble et al’s latest study and research was published on the Scandinavian Journal of Gastroenterology. The groundbreaking study explores the use of faecal calprotectin in primary care and the effect that this will have on cut off values for IBD and IBS.  This work is important as it is the first published study using the calprotectin test in this cohort of patients, it identifies a key issue in respect to cut off values in a population where the incidence of organic disease is considerably lower than that in a referred population. This method has significant benefits if used correctly in a primary care setting both in terms of reducing referrals to secondary care of patients who are likely to have IBS and identifying patients who have organic disease at an earlier stage. As with any biomarker no test will be 100% sensitive. Therefore one is always balancing specificity against sensitivity, but that has to be taken in the context of what the current status quo is (many patients with IBD are missed in primary care due to being labelled as IBS as a consequence of significant symptom overlap) and what the risk of missing disease is. The paper of Dr Tibble demonstrates that by increasing the cut off value for referral in the studied cohort the miss rate of organic disease is low and it is likely that missed cases are those of mild IBD. NICE guidance on the use of calprotectin is still in draft stage and the likelihood is it will support the use of calprotectin in primary care. However this is likely to require further studies before recommending different cut off values in different populations. To view