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Faecal calprotectin for screening of patients with suspected inflammatory bowel disease: diagnostic meta-analysis

BMJ 2010; 341 doi: https://doi.org/10.1136/bmj.c3369 (Published 15 July 2010) Cite this as: BMJ 2010;341:c3369
  1. Patrick F van Rheenen, paediatric gastroenterologist1,
  2. Els Van de Vijver, paediatric gastroenterologist1,
  3. Vaclav Fidler, statistician2
  1. 1Beatrix Children’s Hospital, University Medical Center Groningen, PO Box 30001, 9700 RB Groningen, Netherlands
  2. 2Department of Epidemiology, University Medical Center Groningen, Netherlands
  1. Correspondence to: P F van Rheenen p.f.van.rheenen{at}bkk.umcg.nl
  • Accepted 20 April 2010

Abstract

Objective To evaluate whether including a test for faecal calprotectin, a sensitive marker of intestinal inflammation, in the investigation of suspected inflammatory bowel disease reduces the number of unnecessary endoscopic procedures.

Design Meta-analysis of diagnostic accuracy studies.

Data sources Studies published in Medline and Embase up to October 2009.

Interventions reviewed Measurement of faecal calprotectin level (index test) compared with endoscopy and histopathology of segmental biopsy samples (reference standard).

Inclusion criteria Studies that had collected data prospectively in patients with suspected inflammatory bowel disease and allowed for construction of a two by two table. For each study, sensitivity and specificity of faecal calprotectin were analysed as bivariate data to account for a possible negative correlation within studies.

Results 13 studies were included: six in adults (n=670), seven in children and teenagers (n=371). Inflammatory bowel disease was confirmed by endoscopy in 32% (n=215) of the adults and 61% (n=226) of the children and teenagers. In the studies of adults, the pooled sensitivity and pooled specificity of calprotectin was 0.93 (95% confidence interval 0.85 to 0.97) and 0.96 (0.79 to 0.99) and in the studies of children and teenagers was 0.92 (0.84 to 0.96) and 0.76 (0.62 to 0.86). The lower specificity in the studies of children and teenagers was significantly different from that in the studies of adults (P=0.048). Screening by measuring faecal calprotectin levels would result in a 67% reduction in the number of adults requiring endoscopy. Three of 33 adults who undergo endoscopy will not have inflammatory bowel disease but may have a different condition for which endoscopy is inevitable. The downside of this screening strategy is delayed diagnosis in 6% of adults because of a false negative test result. In the population of children and teenagers, 65 instead of 100 would undergo endoscopy. Nine of them will not have inflammatory bowel disease, and diagnosis will be delayed in 8% of the affected children.

Conclusion Testing for faecal calprotectin is a useful screening tool for identifying patients who are most likely to need endoscopy for suspected inflammatory bowel disease. The discriminative power to safely exclude inflammatory bowel disease was significantly better in studies of adults than in studies of children.

Footnotes

  • We thank S van der Werf (medical librarian, University Medical Center, Groningen) for help with the design of the optimal search strategy for Medline and Embase.

  • Contributors: PFvR and EVdV conceived and designed the study; acquired, analysed, and interpreted the data; and drafted the manuscript. VF analysed and interpreted the data, provided statistical expertise, and critically revised the manuscript. All authors had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis.

  • Funding: This review received no funding.

  • Competing interests: All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare that: (1) they did not receive financial support for the submitted work; (2) they have no relationships with companies that might have an interest in the submitted work in the previous 3 years; (3) their spouses, partners, or children have no financial relationships that may be relevant to the submitted work; and (4) they have no non-financial interests that may be relevant to the submitted work.

  • Ethical approval: Not required.

  • Data sharing: No additional data available.

  • Answer CME questions related to this article.

  • Accepted 20 April 2010

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