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Dr van Rheenen and colleagues from the Netherlands evaluated whether including a test for faecal calprotectin, a sensitive marker of intestinal inflammation, in the investigation of suspected inflammatory bowel disease (IBD) reduces the number of unnecessary endoscopic procedures.
The team performed a meta-analysis of diagnostic accuracy studies.
The researchers identified 13 studies published in Medline and Embase up to 2009.
Interventions reviewed included measurement of fecal calprotectin level (index test) compared with endoscopy and histopathology of segmental biopsy samples (reference standard).
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| IBD was confirmed by endoscopy in 32% of the adults |
| British Medical Journal |
The research team identified studies that had collected data prospectively in patients with suspected inflammatory bowel disease, and allowed for construction of a 2 by 2 table.
For each study, sensitivity and specificity of fecal calprotectin were analyzed as bivariate data to account for a possible negative correlation within studies.
The team reported that 6 studies were performed in adults, 7 in children and teenagers.
Inflammatory bowel disease was confirmed by endoscopy in 32% of the adults, and 61% of the children and teenagers.
In the studies of adults, the pooled sensitivity and pooled specificity of calprotectin was 0.93 and 0.96, and in the studies of children and teenagers was 0.9 and 0.8.
The team noted that lower specificity in the studies of children and teenagers was significantly different from that in the studies of adults.
Screening by measuring fecal calprotectin levels would result in a 67% reduction in the number of adults requiring endoscopy.
The research team found that 3 of 33 adults who undergo endoscopy will not have inflammatory bowel disease but may have a different condition for which endoscopy is inevitable.
The researchers noted that the downside of this screening strategy is delayed diagnosis in 6% of adults because of a false negative test result.
In the population of children and teenagers, the team reported that 65 instead of 100 would undergo endoscopy.
The research team reported that 9 of these will not have inflammatory bowel disease, and diagnosis will be delayed in 8% of the affected children.
Dr van Rheenan's team concludes, "Testing for faecal calprotectin is a useful screening tool for identifying patients who are most likely to need endoscopy for suspected inflammatory bowel disease."
"The discriminative power to safely exclude inflammatory bowel disease was significantly better in studies of adults than in studies of children."
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