Is faecal calprotectin a predictive measure to refer to GI specialist?.

Abstract

Introduction Calprotectin is a calcium binding protein which also classified as a damage associated molecular pattern protein. 1,2 Faecal calprotectin(FC) is patient friendly test measured easily from ELISA technique.3 FC >250micg/g indicates GI inflammation and may require evaluation.4 We noticed high FC was the reason for many referrals to our paediatric GI unit. Objectives 1. To evaluate relationship of common GI symptoms with high FC triggered referral. 2. To evaluate relationship of FC and other investigation to diagnosis Methodology This is a retrospective case notes study at Russells Hall Hospital, District General Hospital in West Midlands between Jan-Dec 2021. We collected data of all the children referred to the Paediatric GI clinic with a FC value during the study period. Data collected and analysed using SPSS. Results 50 set of notes was analysed. (M:F = 48:52, mean age 8.8 years and mean duration of symptoms 7.8 months) There were 16 (32%) of subjects with FC >250micg/g. We analysed relationship of FC in 3 age group: a) <5 years b) 6-10 years and c)>11 years. The commonest symptoms and association with FC and age group described in table 1. IBD was diagnosed on only one occasion (2%) of all referrals and it was associated with FC above 1000mic/g. The commonest diagnosis among the less than 249 & above 250 groups was Functional Constipation with 58% and 28% respectively. (table 2) Raised WBC count, raised ESR had a PPV of 100% for a FC >250. Low albumin level and low Haemoglobin had PPV of 67% and 50% respectively. 38 (76%) of the children referred been discharged within first 2 visits. of 38 children discharged 25 (66%) had FC less than 249 micg/g. Abdominal pain had a PPV for FC >250 of 27%. In children with abdominal pain absence of diarrhoea or bloody stools had a NPV of 74% and 72% for FC <249 respectively. Conclusion In our cohort, FC <250 did not yield a pathological diagnosis and most of them were discharged after first review. None of the children in 1-5 or 6 -10 age groups had a significant condition which can be detected from FC measurements. In children with abdominal pain, absence of diarrhoea or bloody stools will increase the likelihood to have an insignificant FC values. In the children referred high WBC count, high ESR and low albumin increased the likelihood of getting a significant FC level.