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Faecal calprotectin...a #tweetorial
What is FC?
Protein complex found within cytosol of neutrophils
Intestinal inflammation 
influx of neutrophils into gut lumen
FC resistant to enzymatic degradation so easily measured in 
Non-invasive biomarker of intestinal inflammation
Protein complex found within cytosol of neutrophils Intestinal inflammation influx of neutrophils into gut lumen FC resistant to enzymatic degradation so easily measured in Non-invasive biomarker of intestinal inflammation
How do I check FC?
Stool sample in a CALEX tube to Biochem
Ideally first stool of the day
Collection instructions available via FirstPort ( http://shorturl.at/htC48 )
Stool sample in a CALEX tube to Biochem Ideally first stool of the day Collection instructions available via FirstPort ( http://shorturl.at/htC48 )
When should I check FC?
Adult patients 16-40y with new lower GI symptoms (e.g. abdominal pain, diarrhoea) for >4 weeks
Monitoring in IBD
Adult patients 16-40y with new lower GI symptoms (e.g. abdominal pain, diarrhoea) for >4 weeks Monitoring in IBD
Main uses of FC:
Differentiating between IBD (FC typically elevated) and IBS (FC typically normal)
Follow up of IBD patients: surrogate marker for mucosal healing in IBD - can be used to assess disease activity, predict risk of relapse, assess efficacy of treatment
Differentiating between IBD (FC typically elevated) and IBS (FC typically normal) Follow up of IBD patients: surrogate marker for mucosal healing in IBD - can be used to assess disease activity, predict risk of relapse, assess efficacy of treatment
Don’t check FC...
In patients >40y with new lower GI symptoms (send a qFIT then instead...qFIT tweetorial coming soon!)
Acute diarrhoea
As initial test in new bloody diarrhoea - FC invariably elevated in this scenario & colonoscopy warranted provided stool cultures neg
In patients >40y with new lower GI symptoms (send a qFIT then instead...qFIT tweetorial coming soon!) Acute diarrhoea As initial test in new bloody diarrhoea - FC invariably elevated in this scenario & colonoscopy warranted provided stool cultures neg
What’s normal when FC used to differentiate between IBD & IBS?
Normal: FC <100 - in patients aged 16-40y meeting Rome III criteria with normal Hb/inflammatory markers/TTG and no alarm symptoms, manage as IBS
Elevated: >200 - refer to gastro for consideration of colonoscopy
Normal: FC <100 - in patients aged 16-40y meeting Rome III criteria with normal Hb/inflammatory markers/TTG and no alarm symptoms, manage as IBS Elevated: >200 - refer to gastro for consideration of colonoscopy
What about FC results between 100-200?
Equivocal: 100-200 ug/g stool - repeat in 4/12 & refer gastro if ≥100 ug/g stool when repeated
FC <200 ug/g stool rarely associated with IBD or other significant luminal pathology in adult patients 16-40y with no alarm symptoms
Equivocal: 100-200 ug/g stool - repeat in 4/12 & refer gastro if ≥100 ug/g stool when repeated FC <200 ug/g stool rarely associated with IBD or other significant luminal pathology in adult patients 16-40y with no alarm symptoms
Caution...
Elevated FC not diagnostic of IBD - it’s a prompt to consider further investigations to exclude IBD
such as NSAIDs & PPIs can falsely elevate FC
Elevated FC not diagnostic of IBD - it’s a prompt to consider further investigations to exclude IBD such as NSAIDs & PPIs can falsely elevate FC
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