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Bowel disorders
Published in Henry J. Woodford, Essential Geriatrics, 2022
Initial investigations should include blood tests (e.g. FBC, urea and electrolytes, liver function tests, vitamin B12, folate, calcium, ferritin, erythrocyte sedimentation rate, C reactive protein and TSH). When an infectious source is likely, a stool sample can be tested. Faecal calprotectin is a marker of inflammation in the bowel wall, which can be used to help differentiate between IBS and inflammatory bowel disease in younger people. It is less useful in older people. In younger people, a negative faecal haemoglobin tests test makes colorectal cancer less likely and colonoscopy might be avoided. It is unlikely to alter management in older people with a change in bowel habits. Colonoscopy is usually recommended for chronic diarrhoea and will detect an abnormality in 15–20% of cases. In people with moderate to severe frailty, flexible sigmoidoscopy or CT virtual colonoscopy are less invasive alternatives, but will they affect management? CT and MR enterography or capsule endoscopy are sometimes used to image the small bowel.
Common gastrointestinal investigations and psychological concerns
Published in Simon R. Knowles, Laurie Keefer, Antonina A. Mikocka-Walus, Psychogastroenterology for Adults, 2019
A stool sample can be tested for infections, malabsorption, and inflammation. Faecal calprotectin is a useful test that can help to differentiate between inflammatory bowel disease (IBD) and IBS [5]. It is released when there is inflammation in the bowels. A normal faecal calprotectin level (<50ug/g) is highly suggestive of non-inflammatory bowel conditions such as IBS, in the right clinical context. It can also be helpful to assess disease activity, response to treatment, and prediction of disease relapse in IBD [6].
Diagnosis of IBD
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Gregor Novak, Geert D’Haens, Najib Haboubi, John B. Schofield
Faecal calprotectin is a sensitive biomarker that correlates well with intestinal inflammation. It has a high sensitivity and specificity for distinguishing IBD from irritable bowel syndrome and may reduce endoscopies with negative results (see details in the UC part under Laboratory Investigation, Biomarkers for Severity of Disease). Faecal calprotectin is a reliable predictor of active inflammation in CD patients,25 especially in colonic disease. A study of 40 newly diagnosed CD patients showed that the average level of faecal calprotectin in colonic and small bowel CD is similar (890 and 830 μg/g, respectively).102 However, in another study, endoscopic score and histological findings correlated significantly with faecal calprotectin in ileocolonic and colonic CD, but not so in ileal CD.103 In management of CD patients, faecal calprotectin may be used for monitoring disease activity, response to treatment, distinguishing irritable-bowel-syndrome-related symptoms from IBD-related, predicting relapse and post-operative recurrence.25
Fecal calprotectin as a biomarker of intestinal inflammation in ICU patients with diarrhea – testing the pipette method against the collection pin and weighing methods
Published in Scandinavian Journal of Clinical and Laboratory Investigation, 2022
Karoline Hardis, Sarah B. Johansen, Janne Eriksen, Kjeld Damgaard, Peter Derek Christian Leutscher, Soren Jepsen
In the recent years, there has been increasing focus on intestinal dysbiosis and inflammation as contributing disease factors in ICU patients with critical illness. In that context, fecal calprotectin is relevant to consider as a tool for assessment of intestinal inflammation in the ICU setting. The protein is released from activated neutrophil granulocytes, in addition to monocytes and macrophages, as part of the inflammatory response [8,9]. Hence, fecal calprotectin is a biomarker of inflammation in the gastrointestinal tract and is used for screening and monitoring of activity in inflammatory bowel diseases, such as Crohn’s disease and ulcerative colitis [10]. Fecal calprotectin values below 80 mg/kg are considered normal while values between 80 and 160 mg/kg represent a grey zone which may indicate a possible inflammatory response, whereas values above 160 mg/kg are stronger indicative of inflammation in the gastrointestinal tract [11].
Concentration of fecal calprotectin in 11,255 children aged 0–18 years
Published in Scandinavian Journal of Gastroenterology, 2020
Kaija-Leena Kolho, Henrik Alfthan
Fecal calprotectin measurement is mostly used to screen for the possibility of inflammatory bowel disease, IBD. There is no general consensus of the most accurate cut-off for a raised values and cut-offs of > 50 mg/kg, ≥ 100 mg/kg, ≥ 250 mg/kg are most frequently used [1,2]. It is important to keep in mind that the performance of the different calprotectin ELISA assays varies regarding specificity and absolute values [3]. There is also some individual variation on a daily basis but this rarely hampers the diagnostic utility of the measurement [4]. Bowel preparation for endoscopy may affect the levels even for several days after the procedure and therefore it is advised to take a sample if needed either before bowel cleansing has started or not earlier than one week after endoscopy [5].
Prognostic significance of faecal eosinophil granule proteins in inflammatory bowel disease
Published in Scandinavian Journal of Gastroenterology, 2019
Karin Amcoff, Yang Cao, Yaroslava Zhulina, Maria Lampinen, Jonas Halfvarson, Marie Carlson
In the clinical setting, faecal calprotectin is a well-established marker for intestinal inflammation and has been shown to correlate with mucosal inflammation. We have previously shown that consecutive measurements of faecal calprotectin can predict the risk of a relapse in both ulcerative colitis and Crohn's disease [9]. However, the marker is associated with intra- and inter-individual differences in the concentrations [21]. Our new findings may indicate that the combination of faecal calprotectin and faecal EDN or ECP may better reflect disease status in some patients with ulcerative colitis, although significant correlations between the proteins were observed in patients with ulcerative colitis and Crohn´s disease in remission. The observed correlations are in line with our previous data on these markers [22] as well as in a study from Saitoh et al. [23].