P305. An audit of faecal calprotectin testing in suspected inflammatory bowel disease in the under 45's
N. Taylor1, E. Hills1, C. Sheen1, A. Al-Bahrani1, L. Grellier1, 1St Mary's Hospital IOW, Gastroenterology, Newport, United Kingdom
Faecal Calprotectin (FCal) is a major binding protein found in neutrophil granulocytes. It has antimicrobial activity and is thought to be involved in the regulation of inflammatory processes. An increase in FCal has been reported in both inflammatory bowel disease (IBD) and colorectal cancer whereas normal values are usually found in patients with irritable bowel syndrome and in healthy subjects.
We conducted an audit of FCal testing in patients under the age of 45 at St Mary's Hospital, Isle of Wight. Our aim was to determine if FCal testing improved time to diagnosis of IBD compared with conventional methods. This simple stool test was available to both hospital physicians and general practitioners who were notified of its availability in advance of the audit.
141 FCal samples were analysed between June 2011 and February 2012, of which 80 met the criteria for audit. 23 patients had an elevated FCal (>50 µg/g faeces). 18 of these patients went on to have a colonoscopy, diagnosing 6 new cases of IBD (3 Crohn's, 3 ulcerative colitis). Of these 6, all had a FCal level of >200 µg/g faeces, with 5 >300 µg/g. Average time from FCal testing to diagnosis by colonoscopy and histological analysis was 57 days (range 28–85), compared with 58.2 days (range 34–89) in the non-FCal group. Only one patient with a negative FCal was subsequently diagnosed with IBD at colonoscopy. Allowing for the 7 patients with a positive FCal who did not undergo colonoscopy, the sensitivity of FCal in detecting IBD in our audit population was 86%, with a specificity of 82.4%, slightly lower than other published results.
Our audit demonstrates that the early use of FCal can facilitate diagnosis of IBD when used in conjunction with clinical and endoscopic assessment of younger patients. There was a marginal improvement in time to diagnosis using FCal, however the number of new IBD cases was small and further audit may illustrate a more significant improvement. Elevated FCal levels of >300 µg/g faeces were particularly associated with IBD. Early detection of high levels of FCal can allow younger patients to receive prompt treatment which may considerably alter their disease progress.