P126 Ask Twice: The importance of a repeated faecal calprotectin testing prior to diagnostic colonoscopy in an adult inception cohort.. “During the triaging process (for the Rapid Access clinic) it became apparent that the majority of patients only had one result at the point of referral, so patients were sent a sample pot in the post and asked to bring the sample back with them to their first outpatient appointment. The median time between the GP referral and this second result was 34 days. During this project, we did not reject referrals due to the lack of a second test, but we did delay the request for a colonoscopy until the second test was available in those with a borderline initial result or the clinical history was not strongly suggestive of IBD. This was only a few days as most brought the sample along to the appointment.” The data presented in the ECCO poster showed that there were 425 patients with a single calprotectin result and 185 patients who had two calprotectin results (using BÜHLMANN fCAL turbo on Abbott Alinity analysers) and a final diagnosis between January 2021 and November 2022. There was a significant difference in the median initial calprotectin which was 949µg/g for patients who were subsequently diagnosed with IBD compared to 353µg/g for those who didn’t have IBD. If two results were available, then the difference was even more pronounced with 749µg/g for those with IBD compared to 34µg/g for those without. This data is presented in the graphs below: We are all very familiar with the use of faecal calprotectin testing to help distinguish inflammatory bowel disease (IBD) from functional disorders, and it has become a staple tool to support the clinical teams in their diagnosis and management of patients. If a negative faecal calprotectin result is obtained the cause of a patient’s symptoms is unlikely to be IBD However, calprotectin is a non-specific marker for inflammation, and so a high result may be due to something other than IBD. The literature highlights numerous other situations that can cause (usually transient) increases in the calprotectin concentration found in stool samples, for example: • Use of certain medication e.g. NSAIDs, proton pump inhibitors • Diverticulitis • Infections e.g. Salmonella, Campylobacter • Stomach/duodenal ulcers • Excessive alcohol • Cancer Basically, anything that causes an irritation/ inflammatory response in the digestive system (mouth to anus) can cause an increase in calprotectin concentrations. Whereas a negative calprotectin is a good rule out for IBD, a positive calprotectin result isn’t necessarily a cause for instant referral to secondary care. The Queen Elizabeth Hospital in Birmingham introduced a rapid access ‘Inception IBD’ clinic based on symptoms and a raised faecal calprotectin test. Dr Peter Rimmer presented their findings and some proposed changes to the pathway at the European Crohn’s and Colitis Organisation (ECCO) conference in Copenhagen earlier this year: The importance of repeated testing prior to diagnostic colonoscopy in an adult inception cohort - Comparison of first and second testing Ask Twice Dr Peter Rimmer, The Queen Elizabeth Hospital, Birmingham Author - Amanda Appleton, Senior Product Manager, Alpha Laboratories Ltd. Faecal Calprotectin Perspective 2
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