Faecal calprotectin in primary care: is its current use supported by the evidence?

• Published in: British journal of general practice Vol. 74; no. 740; pp. 134 - 136
• Main Authors: Perry, Robert W, Mummery, David, Alexander, James L, Hicks, Lucy C, Williams, Horace Rt
• Format: Journal Article
• Language: English
• Published: England Royal College of General Practitioners 01.03.2024
• Subjects: Biomarkers - analysis; Colorectal cancer; Diagnostic tests; Evidence-Based Medicine; Feces - chemistry; Humans; Inflammatory bowel disease; Inflammatory Bowel Diseases - diagnosis; Leukocyte L1 Antigen Complex - analysis; Medical diagnosis; Primary care; Primary Health Care
• ISSN: 0960-1643; 1478-5242; 1478-5242
• DOI: 10.3399/bjgp24X736665

Perry et al discuss fecal calprotectin (FC), which is a widely used screening test for gastrointestinal inflammation, particularly in patients with inflammatory bowel disease (IBD), highlighting the best practices and areas in which outstanding questions and uncertainties remain. FC's low cost and potential to reduce unnecessary referrals have led to its adoption in primary care. However, concerns have been raised about the referral of patients with borderline elevated calprotectin levels. The National Institute for Health and Care Excellence (NICE) guidelines recommend FC use in patients with new-onset lower gastrointestinal symptoms, where IBD or irritable bowel syndrome (IBS) is being considered. FC should not be used if cancer is suspected. The guidelines also suggest using faecal immunochemical testing (FIT) for colorectal cancer detection. The diagnostic performance of FC in differentiating between IBS and IBD is high, but its specificity is lower in primary care settings.