Rational Use of Fecal Calprotectin in Irritable Bowel Syndrome and Inflammatory Bowel Disease
-
Roberto Catanzaro
,
Alfio Maugeri Maugeri
,
Morena Sciuto
,
Fang He
,
Baskar Balakrishnan
,
Francesco Marotta
Abstract
The gastrointestinal pathologies have increased over the last years. The clinical pictures of inflammatory and irritable bowel disease might overlap, leading to expensive and invasive tests. Our study aims to investigate fecal calprotectin as an effective tool for differential diagnosis of gastrointestinal disorders. Two hundred fifty-six patients with the diagnosis of the gastrointestinal disorder and subjected to colonoscopy were collected for the statistical analysis of fecal calprotectin. The differential diagnosis of intestinal inflammation or non-inflammation was performed according to the Receiver Operating Characteristic (ROC) curve that outlines the Area Under Curve (AUC), Sensitivity (Se), Specificity (Sp). Fecal calprotectin was significantly elevated in patients with inflammatory bowel disease compared with patients with irritable bowel syndrome. Especially, the mean values of fecal calprotectin were 522 mg/g (IQR=215-975) and 21 mg/g (IQR=14-34.5) in patients with and without inflammation, respectively (P<0.0001). AUC value of fecal calprotectin was 0.958 (Se=88.9%, Sp=91.1%, with a cut-off value of 50 mg/g) for differentiating between inflammatory bowel disease and irritable bowel syndrome. Fecal calprotectin seems to be a non-invasive and inexpensive biomarker useful for the purpose of a differential diagnosis between inflammatory bowel disease and irritable bowel syndrome.
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13. Cho JH, Weaver CT. The genetics of inflammatory bowel disease. Gastroenterology 2007;133:1327-39.
14. Sun Y, Li L, Xie R, Wang B, Jiang K, Cao H. Stress Triggers Flare of Inflammatory Bowel Disease in Children and Adults. Front Pediatr 2019;7:432.
15. De Lange KM, Barrett JC. Understanding inflammatory bowel disease via immunogenetics. J Autoimmun 2015;64:91-100.
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17. Drossman DA. Functional Gastrointestinal Disorders: History, Pathophysiology, Clinical Features, and Rome IV. Gastroenterology 2016;S0016-5085(16)00223-7.
18. Berens S, Schaefert R, Baumeister D, Gauss A, Eich W, Tesarz J. Does symptom activity explain psychological differences in patients with irritable bowel syndrome and inflammatory bowel disease? Results from a multi-center cross-sectional study. J Psychosom Res 2019;126:109836.
19. Costa F, Mumolo MG, Marchi S, Bellini M. Differential diagnosis between functional and organic intestinal disorders: is there a role for non-invasive tests? World J Gastroenterol 2007;13:219-23.
20. Kamal A, Padival R, Lashner B. Inflammatory Bowel Disease and Irritable Bowel Syndrome: What to Do When There Is an Overlap. Inflamm Bowel Dis 2018;24:2479-82.
21. Abraham BP, Kane S. Fecal Markers: Calprotectin and Lactoferrin. Gastroenterol Clin North Am 2012;41:483-95.
22. Ometto F, Friso L, Astorri D, Botsios C, Raffeiner B, Punzi L, et al. Calprotectin in rheumatic diseases. Exp Biol Med (Maywood) 2017;242:859-73.
23. Lamb CA, Mansfield JC. Measurement of faecal calprotectin and lactoferrin in inflammatory bowel disease. Frontline Gastroenterol 2011;2:13-8.
24. Sipponen T. Diagnostics and Prognostics of Inflammatory Bowel Disease with Fecal Neutrophil-Derived Biomarkers Calprotectin and Lactoferrin. Dig Dis 2013;31:336-44.
25. Gimeno-García AZ, Quintero E. Colonoscopy appropriateness: Really needed or a waste of time? World J Gastrointest Endosc 2015;7:94-101.
26. Catalano F, Catanzaro R, Branciforte G, Bentivegna CF, Cipolla R, Brogna A, et al. Colonoscopy Technique With an External Straightener. Gastrointest Endosc 2000;51:600-4.
27. Otten CMT, Kok L, Witteman BJM, Baumgarten R, Kampman E, Moons KGM, et al. Diagnostic Performance of Rapid Tests for Detection of Fecal Calprotectin and Lactoferrin and Their Ability to Discriminate Inflammatory From Irritable Bowel Syndrome. Clin Chem Lab Med 2008;46:1275-80.
28. Banerjee A, Srinivas M, Eyre R, Ellis R, Waugh N, Bardhan KD, et al. Faecal Calprotectin for Differentiating Between Irritable Bowel Syndrome and Inflammatory Bowel Disease: A Useful Screen in Daily Gastroenterology Practice. Frontline Gastroenterol 2015;6:20-6.
29. Lozoya Angulo ME, de Las Heras Gómez I, Martinez Villanueva M, Noguera Velasco JA, Avilés Plaza F. Faecal Calprotectin, an Useful Marker in Discriminating Between Inflammatory Bowel Disease and Functional Gastrointestinal Disorders. Gastroenterol Hepatol 2017;40:125-31.
30. Carroccio A, Iacono G, Cottone M, Di Prima L, Cartabellotta F, Cavataio F, et al. Diagnostic Accuracy of Fecal Calprotectin Assay in Distinguishing Organic Causes of Chronic Diarrhea From Irritable Bowel Syndrome: A Prospective Study in Adults and Children. Clin Chem 2003;49:861-7.
31. Adriani A, Ribaldone DG, Astegiano M, Durazzo M, Saracco GM, Pellicano R. Irritable bowel syndrome: the clinical approach. Panminerva Med 2018;60:213-22.
32. Canavan C, West J, Card T. Review article: the economic impact of the irritable bowel syndrome. Aliment Pharmacol Ther 2014;40:1023-34.
33. Hillilä MT, Färkkilä NJ, Färkkilä MA. Societal costs for irritable bowel syndrome - a population based study. Scand J Gastroenterol 2010;45:582-91.
2. El-Salhy M, Hatlebakk JG, Hausken T. Diet in Irritable Bowel Syndrome (IBS): Interaction With Gut Microbiota and Gut Hormones. Nutrients 2019;11:1824.
3. Flynn S, Eisenstein S. Inflammatory Bowel Disease Presentation and Diagnosis. Surg Clin North Am 2019;99:1051-62.
4. Saha L. Irritable bowel syndrome: Pathogenesis, diagnosis, treatment, and evidence-based medicine. World J Gastroenterol 2014;20:6759-73.
5. Lewis JD. A Review of the Epidemiology of Inflammatory Bowel Disease with a Focus on Diet, Infections and Antibiotic Exposure. Nestle Nutr Inst Workshop Ser 2014;79:1-18.
6. Lacy BE, Patel NK. Rome Criteria and a Diagnostic Approach to Irritable Bowel Syndrome. J Clin Med 2017;6:99.
7. Mearin F, Lacy BE. Diagnostic criteria in IBS: useful or not? Neurogastroenterol Motil 2012;24:791-801.
8. Conrad K, Roggenbuck D, Laass MW. Diagnosis and classification of ulcerative colitis. Autoimmun Rev 2014;13:463-6.
9. Laass MW, Roggenbuck D, Conrad K. Diagnosis and classification of Crohn's disease. Autoimmun Rev 2014;13:467-71.
10. Burri E, Beglinger C. The use of fecal calprotectin as a biomarker in gastrointestinal disease. Expert Rev Gastroenterol Hepatol 2013;8:197-210.
11. Mumolo MG, Bertani L, Ceccarelli L, Laino G, Di Fluri G, Albano E, et al. From Bench to Bedside: Fecal Calprotectin in Inflammatory Bowel Diseases Clinical Setting. World J Gastroenterol 2018;24:3681-94.
12. Zhang YZ, Li YY. Inflammatory bowel disease: pathogenesis. World J Gastroenterol 2014;20:91-9.
13. Cho JH, Weaver CT. The genetics of inflammatory bowel disease. Gastroenterology 2007;133:1327-39.
14. Sun Y, Li L, Xie R, Wang B, Jiang K, Cao H. Stress Triggers Flare of Inflammatory Bowel Disease in Children and Adults. Front Pediatr 2019;7:432.
15. De Lange KM, Barrett JC. Understanding inflammatory bowel disease via immunogenetics. J Autoimmun 2015;64:91-100.
16. Hadjivasilis A, Tsioutis C, Michalinos A, Ntourakis D, Christodoulou DK, Agouridis AP. New insights into irritable bowel syndrome: from pathophysiology to treatment. Ann Gastroenterol 2019;32:554-64.
17. Drossman DA. Functional Gastrointestinal Disorders: History, Pathophysiology, Clinical Features, and Rome IV. Gastroenterology 2016;S0016-5085(16)00223-7.
18. Berens S, Schaefert R, Baumeister D, Gauss A, Eich W, Tesarz J. Does symptom activity explain psychological differences in patients with irritable bowel syndrome and inflammatory bowel disease? Results from a multi-center cross-sectional study. J Psychosom Res 2019;126:109836.
19. Costa F, Mumolo MG, Marchi S, Bellini M. Differential diagnosis between functional and organic intestinal disorders: is there a role for non-invasive tests? World J Gastroenterol 2007;13:219-23.
20. Kamal A, Padival R, Lashner B. Inflammatory Bowel Disease and Irritable Bowel Syndrome: What to Do When There Is an Overlap. Inflamm Bowel Dis 2018;24:2479-82.
21. Abraham BP, Kane S. Fecal Markers: Calprotectin and Lactoferrin. Gastroenterol Clin North Am 2012;41:483-95.
22. Ometto F, Friso L, Astorri D, Botsios C, Raffeiner B, Punzi L, et al. Calprotectin in rheumatic diseases. Exp Biol Med (Maywood) 2017;242:859-73.
23. Lamb CA, Mansfield JC. Measurement of faecal calprotectin and lactoferrin in inflammatory bowel disease. Frontline Gastroenterol 2011;2:13-8.
24. Sipponen T. Diagnostics and Prognostics of Inflammatory Bowel Disease with Fecal Neutrophil-Derived Biomarkers Calprotectin and Lactoferrin. Dig Dis 2013;31:336-44.
25. Gimeno-García AZ, Quintero E. Colonoscopy appropriateness: Really needed or a waste of time? World J Gastrointest Endosc 2015;7:94-101.
26. Catalano F, Catanzaro R, Branciforte G, Bentivegna CF, Cipolla R, Brogna A, et al. Colonoscopy Technique With an External Straightener. Gastrointest Endosc 2000;51:600-4.
27. Otten CMT, Kok L, Witteman BJM, Baumgarten R, Kampman E, Moons KGM, et al. Diagnostic Performance of Rapid Tests for Detection of Fecal Calprotectin and Lactoferrin and Their Ability to Discriminate Inflammatory From Irritable Bowel Syndrome. Clin Chem Lab Med 2008;46:1275-80.
28. Banerjee A, Srinivas M, Eyre R, Ellis R, Waugh N, Bardhan KD, et al. Faecal Calprotectin for Differentiating Between Irritable Bowel Syndrome and Inflammatory Bowel Disease: A Useful Screen in Daily Gastroenterology Practice. Frontline Gastroenterol 2015;6:20-6.
29. Lozoya Angulo ME, de Las Heras Gómez I, Martinez Villanueva M, Noguera Velasco JA, Avilés Plaza F. Faecal Calprotectin, an Useful Marker in Discriminating Between Inflammatory Bowel Disease and Functional Gastrointestinal Disorders. Gastroenterol Hepatol 2017;40:125-31.
30. Carroccio A, Iacono G, Cottone M, Di Prima L, Cartabellotta F, Cavataio F, et al. Diagnostic Accuracy of Fecal Calprotectin Assay in Distinguishing Organic Causes of Chronic Diarrhea From Irritable Bowel Syndrome: A Prospective Study in Adults and Children. Clin Chem 2003;49:861-7.
31. Adriani A, Ribaldone DG, Astegiano M, Durazzo M, Saracco GM, Pellicano R. Irritable bowel syndrome: the clinical approach. Panminerva Med 2018;60:213-22.
32. Canavan C, West J, Card T. Review article: the economic impact of the irritable bowel syndrome. Aliment Pharmacol Ther 2014;40:1023-34.
33. Hillilä MT, Färkkilä NJ, Färkkilä MA. Societal costs for irritable bowel syndrome - a population based study. Scand J Gastroenterol 2010;45:582-91.
| Files | ||
| Issue | Vol 59, No 4 (2021) | |
| Section | Articles | |
| DOI | https://doi.org/10.18502/acta.v59i4.6217 | |
| Keywords | ||
| Fecal calprotectin Irritable bowel syndrome Inflammatory bowel diseases Ulcerative colitis Crohn's disease | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Catanzaro R, Maugeri AM, Sciuto M, He F, Balakrishnan B, Marotta F. Rational Use of Fecal Calprotectin in Irritable Bowel Syndrome and Inflammatory Bowel Disease. Acta Med Iran. 2021;59(4):197-202.
