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P123. The use of faecal calprotectin in IBD and reducing unnecessary colonoscopy

M. Johnson1, K. Lithgo1, T. Price2, T. Cacciattolo1, S. Steve1, 1Luton & Dunstable University Hospital foundation trust NHS, Gastroenterology, Luton, United Kingdom, 2The Luton & Dunstable University Hospital Foundation Trust NHS, Gastroenterology, Luton, United Kingdom

Background

Faecal calprotectin (FC) are capable of differentiating between organic and functional bowel disease with a 93% sensitivity and 96% specificity. Where the diagnosis is unclear, FC can be used to spare unnecessary invasive colonoscopy. Functional symptoms are said to occur in 60% of ulcerative colitis (UC) and 40% of Crohn's disease patients. This can create a difficult management dilemma, which in turn can lead to both over, and under, treatment of presumed flares in the patients with inflammatory bowel disease.

Methods

Over a 6 month period FC data was collected from known IBD patients, where a colonoscopy was being considered because of diagnostic uncertainty about whether they were suffering from organic or functional (IBS) symptoms. A normal, borderline and high result was recorded when levels were <50, 50–100 and >100 µg/g, respectively. A retrospective review was performed to assess the diagnostic and management outcome.

Results

In the IBD patients colonoscopy was spared in 84% (37/44), including 13/14 with normal FC, 8/9 with borderline FC and 16/21 with high FC. In the IBD cohort the FC changed management in 10/14 with normal results, 4/9 with borderline results and 16/21 with high results.

Conclusion

With the increasing demand being made on colonoscopy units throughout UK, a greater utilization of faecal calprotectin into general clinical practice could help safely relieve some of this burden. This can be used to help maintain adequate endoscopy waiting times, whilst also lightening the financial burden for the Clinical Commisioning Groups. Many hospitals are now adopting FC testing into their IBS investigation and referral pathways for general practitioners, prior to them considering referrals to the hospital based gastroenterology specialists. In known IBD patients Faecal Calprotectin assessments spared 84% of colonoscopy, as both negative and positive result directly influenced subsequent management. We believe this is an incredibly useful test in helping to provide clinicians the confidence to focus on treating functional bowel symptoms and tailor down escalating management regimes in those with normal result.