The use of fecal calprotectin as a biomarker in gastrointestinal disease

Abstract

Abdominal discomfort including pain, bloating and diarrhea is common. It often arises from functional gastrointestinal disorders but may indicate inflammatory bowel disease (IBD). Calprotectin is an abundant neutrophil protein that is released during inflammation. When measured in feces, it can be used to differentiate between non-organic and inflammatory intestinal disorders, especially to identify IBD. Fecal calprotectin might also be useful to monitor patients with IBD under treatment and to predict the risk of recurrence of active disease prior to clinical relapse. The use of fecal calprotectin has been investigated in a number of gastrointestinal disorders other than IBD, for example, as screening test for colorectal cancer but the available data are limited. This article summarizes the current literature on the use of fecal calprotectin in clinical practice.

Keywords::

• acid-related disorders
• celiac disease
• colorectal cancer
• fecal calprotectin
• graft-versus-host disease
• inflammatory bowel disease
• infectious gastroenteritis
• intestinal transplant rejection
• irritable bowel syndrome
• microscopic colitis
• small intestinal bacterial overgrowth

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Fecal calprotectin is a valuable marker of inflammatory intestinal disease, especially to decide on urgent endoscopy, and is highly useful to identify patients with inflammatory bowel disease (IBD).

• Fecal calprotectin values correlate well with endoscopic disease activity in IBD and are superior to C-reactive protein and clinical activity indices in detecting mucosal inflammation. In Crohn's disease, the correlation is better for colonic than for ileal disease.

• Measurement of fecal calprotectin might be useful to stratify patients according to their risk for disease relapse in IBD. Currently, data on cut-off values are inconclusive and reports from prospective intervention studies using calprotectin-guided therapy strategies to investigate the long-term outcome of IBD are not yet available.

• The available evidence suggests that measurement of fecal calprotectin is not sufficiently accurate to identify colorectal carcinoma and the diagnostic precision to detect adenomatous polyps is inadequate to use it as screening test in average risk patients.

• Data on the use of fecal calprotectin in other intestinal disorders, for example, infectious gastroenteritis, non-steroidal anti-inflammatory drug -induced small bowel enteropathy, diverticular disease, microscopic colitis, acid-related disorders, celiac disease, small intestinal bacterial overgrowth, transplant rejection and graft-versus-host disease is yet inconclusive but mostly of limited value.