Is NICE too optimistic about savings from normal faecal calprotectin results?
Chambers, Samantha Malik, Ahmad Lee, Bee Sung, Edmond Nwokolo, Chuka Waugh, Norman Arasaradnam, Ramesh
Chambers, Samantha
Malik, Ahmad
Lee, Bee
Sung, Edmond
Nwokolo, Chuka
Waugh, Norman
Arasaradnam, Ramesh
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Affiliation
University Hospitals Coventry and Warwickshire NHS Trust; South Warwickshire University NHS Foundation Trust; George Eliot Hospital NHS Trust, Nuneaton; University of Warwick
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Publication date
2016-02-21
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Abstract
Background: A recent systematic review confirmed the utility of faecal calprotectin (FC) in distinguishing organic (inflammatory bowel disease) from non-organic gastrointestinal disease (irritable bowel syndrome). FC levels <50 mcg/g have a negative predictive value >92% to exclude organic GI disease. Levels >250mcg/g correlate with endoscopic IBD disease activity; sensitivity 90%. This study aimed to determine clinical outcomes in those with a normal FC result.
Method: Adults (>16 years old) with FC results between July 2012 - October 2013 were reviewed. Clinical data was collected from hospital databases and General Practitioners (GPs). GPs were provided with a referral pathway prior introduction of FC in 2012. Clinical data at 12 months post index FC test was available in 275 patients; 208 normal, 41 intermediate and 26 raised results.
Results: A new IBD diagnosis was made in only 1% of patients with a normal FC result. Conversely, a new IBS diagnosis was made in a further 40% of normal FC results referred to secondary care. Despite a normal FC and referral guidance, 40% of patients were still referred to secondary care.
Conclusions: Normal FC testing remains a useful test in excluding organic GI conditions, although 40% were still referred to secondary care despite a normal FC. Despite a normal FC, 6% still remained in secondary care at 12 months without a new diagnosis.
Citation
McFarlane M, Chambers S, Malik A, Lee B, Sung E, Nwokolo C, Waugh N, Arasaradnam R. Is NICE too optimistic about savings from normal faecal calprotectin results? Journal of Gastroenterology and Hepatology Research. 2016 February 21;5(1):1895-1898. doi: 10.17554/j.issn.2224-3992.2016.05.580.
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Article