Fecal calprotectin values have been shown to correlate with endoscopic and histological assessment of disease activity in IBD patients. Fecal calprotectin can aid in this detection, as well as provide a noninvasive means to track disease activity, risk of relapse, and response to treatment. Because levels of inflammation reflect severity of the disease process, detection and monitoring are key to clinical management. IBD, which includes Crohn’s disease and ulcerative colitis, is marked by chronic, recurrent episodes of inflammation in the gastrointestinal tract. 3 Assessing fecal calprotectin first can help clinicians identify patients with abdominal symptoms who are likely to benefit from more invasive diagnostic procedures. As a diagnostic test overall, fecal calprotectin shows a 95% sensitivity and 91% specificity for identifying IBD patients. 2 Meta-analysis of multiple similar studies involving nearly 6000 patients demonstrates even greater test sensitivity and specificity. In a study of 600 patients referred to a gastroenterology clinic with symptoms suggestive of either IBS or inflammatory intestinal disease, the sensitivity and specificity of calprotectin for predicting inflammatory disease were 89% and 79%, respectively. In most patients presenting with common intestinal symptoms, a normal fecal calprotectin can help clinicians rule out active IBD without the need for colonoscopy. Because IBS is a functional disorder, the absence of biomarkers of intestinal inflammation such as fecal calprotectin can point toward an IBS diagnosis. Many patients in the IBS category are still routinely investigated with extensive and invasive imaging studies to rule out IBD. 1Ī key problem in gastroenterology is the clinical differentiation of IBD and irritable bowel syndrome (IBS). Elevated concentrations of fecal calprotectin have been found in patients with infectious and inflammatory conditions, including IBD. Calprotectin is an abundant neutrophil protein, and its presence in stool is indicative of neutrophilic infiltration into the gut lumen associated with inflammation. Such damage may be associated with a variety of causes, including acute or chronic intestinal infection (viral, bacterial or parasitic), IBD, diverticulitis, celiac disease, food allergy, NSAID-induced enteropathy, and colorectal cancer.ĭiagnosTechs has offered stool markers of intestinal inflammation for some time, and we also now offer a test for fecal calprotectin. Elevated stool inflammatory biomarkers point to an active process of intestinal mucosal cell damage. Laboratory stool analysis is the most convenient and noninvasive means of assessing inflammation in the intestinal tract. It also is indicated for complaints such as fever, weight loss, and fatigue, which are often associated with inflammatory bowel disease (IBD) or other inflammatory intestinal disorders.īecause intestinal inflammation is not directly observable by patients or clinicians, laboratory assays provide critical information to help determine the presence, location, and magnitude of such inflammation. Because it demonstrates features of celiac disease not detected with barium examination, CT may be more sensitive than barium examination for diagnosis of this disease.By DiagnosTechs ChronoBiology 16 October 8, 2013Īssessing the presence, severity, and extent of intestinal inflammation is an essential component in the workup of patients with common digestive complaints such as abdominal pain and cramping, bowel movement disturbances, bloating, and flatulence. Pattern recognition for the diagnosis of small bowel diseases that create structural changes in the bowel wall is well accepted. The abnormal CT findings seen over the past decade during review of more than 200 cases of celiac disease demonstrate that CT depicts more features of celiac disease than did barium examination. Detection of celiac disease with CT will allow treatment to be initiated to prevent the significant morbidity and increased mortality associated with a delay in diagnosis. Improved CT resolution now permits better depiction of the small bowel, colon, and mesenteric lymph nodes, all of which are affected by celiac disease. Abdominal pain in celiac disease is a common early complaint that often leads to computed tomography (CT). The number of barium examinations performed and the skill necessary to interpret their results are both in decline. Although not specific, that pattern prompted further patient evaluation. In the past, barium examination of the small bowel demonstrated a pattern of abnormal findings caused by the pathophysiologic changes induced by malabsorption, thus leading to diagnosis of celiac disease and other diseases of malabsorption. However, less than 10% of cases are currently diagnosed, with a diagnostic delay of more than 10 years from onset of symptoms. Celiac disease is now recognized as a common disease, occurring in about one in every 200 Americans.
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