Intended for healthcare professionals

Practice Rational Testing

The role of faecal calprotectin in the diagnosis of inflammatory bowel disease

BMJ 2023; 380 doi: (Published 13 February 2023) Cite this as: BMJ 2023;380:e068947
  1. Mohammed Deputy12,
  2. Ratnakar Devanaboina3,
  3. Ibrahim Al Bakir45,
  4. Elaine Burns12,
  5. Omar Faiz12
  1. 1Surgical Epidemiology, Trials and Outcome Centre, St Mark’s Hospital and Academic Institute, Harrow, UK
  2. 2Department of Surgery and Cancer, Imperial College London, London, UK
  3. 3Homerton University Hospital NHS Foundation Trust, London, UK
  4. 4Barts Cancer Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
  5. 5Inflammatory Bowel Disease Unit, St Mark’s Hospital and Academic Institute, Harrow, UK
  1. Correspondence to: M Deputy m.deputy{at}

What you need to know

  • Faecal calprotectin testing is recommended in patients <60 years old with lower gastrointestinal symptoms and normal initial workup to exclude causes of colonic inflammation

  • A normal faecal calprotectin result has a high negative predictive value for inflammatory bowel disease, and prevents unnecessary investigation when the most likely diagnosis is irritable bowel syndrome

  • Faecal calprotectin should not be used in patients older than 60 or if colorectal cancer is suspected

  • Faecal calprotectin is a sensitive marker of intestinal inflammation and may be elevated in conditions other than inflammatory bowel disease, such as diverticulitis and infectious gastroenteritis, or when patients take medications such as non-steroidal anti-inflammatory drugs (NSAIDs) and aspirin

A 21 year old presents to her general practitioner with a two month history of abdominal pain, bloating, and fatigue. She reports intermittent loose stools but has not passed any blood. She has no other medical history. On examination, she looks generally well, and the abdomen is soft and non-tender. Her GP requests a full blood count, urea and electrolytes, liver function test, C reactive protein, coeliac screen, thyroid function test, and stool culture; and all return normal results.

Gastrointestinal and abdominal symptoms are common in general practice, being recorded in up to 10% of consultations.1 The symptoms can be caused by a variety of conditions including inflammatory bowel disease and functional disorders such as irritable bowel syndrome. It is often difficult to distinguish between inflammatory bowel disease and irritable bowel syndrome on history and examination alone. Patients with irritable bowel syndrome may undergo costly, invasive, and unnecessary investigations (typically in the form of lower gastrointestinal endoscopy) in order to rule out other conditions.23

Differentiating between inflammatory bowel disease and irritable bowel syndrome

Inflammatory bowel disease includes ulcerative colitis and Crohn’s disease. These are chronic diseases characterised by relapsing and remitting inflammation of the gastrointestinal tract. The prevalence …

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