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P218. Faecal calprotectin testing reduces need for paediatric colonoscopy

T.I. Hassan1, C. Hensey1, M. Hamzawi1, S. Kiernana1, A.-M. Broderick1,2, B. Bourke1,2, S. Hussey1,2, 1Our Lady's Children's Hospital Crumlin, Gastroenterology, Dublin, Ireland, 2University college Dublin, National children reseach centre and school of Medicine and Medical Science, Dublin, Ireland

Background

Ireland has a single national centre for paediatric gastroenterology. Up to 70% of children referred to a paediatric gastroenterology centre with suspected inflammatory bowel disease (IBD) do not have the disease. Faecal calprotectin (FC) is a white cell protein and a marker of intestinal inflammation. Faecal calprotectin was recently made available in our institution.

Our aim was to assess the clinical performance and cost-benefit of faecal calprotectin (FC) in reducing diagnostic endoscopic procedures in symptomatic children with potential or confirmed inflammatory bowel disease (IBD).

Methods

Charts, computerised records and endoscopy results of all patients who had FC testing between Oct 2012 and August 2013 were retrospectively reviewed. New patients with a high clinical likelihood of IBD do not get routine FC testing and were not included in the analysis. FC values <50 µg/g were considered normal; 51 to 200 µg/g - indeterminate and >200 µg/g - likely to have active GI inflammation.

Results

133 patients had a FC test; of these, 57 (42.8%) had FC >200 (Group A), 76 had FC <200 (Group B). The results are summarised in Table 1.

25/57 patients in group A had colonoscopy (43.8%); 11 were newly diagnosed with IBD; 4 of 6 patients with pre-existing IBD had a change in phenotype or treatment regimen following endoscopy findings. Two patients in group A had normal colonoscopy despite high FC. Of the rest in the same group, one patient was diagnosed as proctitis while three had gastritis. 32/57 patients in group A had no colonscopy performed, 24 of these were known to have IBD and five were found to have bacterial or viral GI infection. 10 out of 76 patients in Group B had colonoscopy performed (13.1%), mostly due to persistent symptoms of diarrhoea and/or abdominal pain. None of these had macro- or microscopic abnormalities. Using estimated costs of FC (euro 75 per test) and colonoscopy (euro1000/test), the calculated net cost saving in the year examined was euro 60,300.

Table 1. The analysis of the FC and the endoscopy results
Faecal calprotectin (µg/g)Total (n = 133)Colonoscopy (n = 35)No colonoscopy (n = 98)Known IBD (n = 33)New IBD (n = 11)
<50486421
50–200284243
<2007610664
>2005725322911

Conclusion

Faecal calprotectin is a valuable, cost-effective screening test for excluding significant intestinal inflammatory disease and avoiding colonoscopy in children with non-organic gastrointestinal symptoms that mimic IBD.