Faecal haemoglobin and faecal calprotectin as indicators of bowel disease in patients presenting to primary care with bowel symptoms
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Open Access
- 9 August 2015
- Vol. 65 (9), 1463-1469
- https://doi.org/10.1136/gutjnl-2015-309579
Abstract
Objective In primary care, assessing which patients with bowel symptoms harbour significant disease (cancer, higher-risk adenoma or IBD) is difficult. We studied the diagnostic accuracies of faecal haemoglobin (FHb) and faecal calprotectin (FC) in a cohort of symptomatic patients. Design From October 2013 to March 2014, general practitioners were prompted to request FHb and FC when referring patients with bowel symptoms to secondary care. Faecal samples were analysed for haemoglobin (EIKEN OC-Sensor io) and calprotectin (BÜHLMANN Calprotectin ELISA). Patients triaged to endoscopy were investigated within 6 weeks. All clinicians and endoscopists were blind to the faecal test results. The diagnostic accuracies of FHb and FC for identification of significant bowel disease were assessed. Results 1043 patients returned samples. FHb was detectable in 57.6% (median 0.4 µg/g, 95% CI 0.4 to 0.8; range 0–200). FC at 50 µg/g or above was present in 60.0%. 755 patients (54.6% women, median age 64 years (range 16–90, IQR 52–73)) returned samples and completed colonic investigations. 103 patients had significant bowel disease; the negative predictive values of FHb for colorectal cancer, higher-risk adenoma and IBD were 100%, 97.8% and 98.4%, respectively. Using cut-offs of detectable FHb and/or 200 µg/g FC detected two further cases of IBD, one higher-risk adenoma and no additional cancers. Conclusions In primary care, undetectable FHb is a good ‘rule-out’ test for significant bowel disease and could guide who requires investigation.Keywords
This publication has 25 references indexed in Scilit:
- Advances in Fecal Occult Blood Tests: The FIT RevolutionDigestive Diseases and Sciences, 2014
- Difference in Performance of Fecal Immunochemical Tests With the Same Hemoglobin Cutoff Concentration in a Nationwide Colorectal Cancer Screening ProgramGastroenterology, 2014
- Population Screening for Colorectal Cancer Means Getting FIT: The Past, Present, and Future of Colorectal Cancer Screening Using the Fecal Immunochemical Test for Hemoglobin (FIT)Gut and Liver, 2014
- Diagnostic accuracy of the faecal immunochemical test for colorectal cancer in symptomatic patients: comparison with NICE and SIGN referral criteriaColorectal Disease, 2014
- Quantitation of Hemoglobin Improves Fecal Immunochemical Tests for Noninvasive ScreeningClinical Gastroenterology and Hepatology, 2013
- Immunological faecal occult blood testing: A discriminatory test to identify colorectal cancer in symptomatic patientsInternational Journal of Surgery, 2013
- Guidelines for Colonoscopy Surveillance After Screening and Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal CancerGastroenterology, 2012
- Diagnostic Accuracy of Point-of-Care Fecal Calprotectin and Immunochemical Occult Blood Tests for Diagnosis of Organic Bowel Disease in Primary Care: The Cost-Effectiveness of a Decision Rule for Abdominal Complaints in Primary Care (CEDAR) StudyClinical Chemistry, 2012
- Faecal haemoglobin concentrations by gender and age: implications for population-based screening for colorectal cancercclm, 2011
- Correlation between Faecal Excretion of Indium-111-Labelled Granulocytes and Calprotectin, a Granulocyte Marker Protein, in Patients with Inflammatory Bowel DiseaseScandinavian Journal of Gastroenterology, 1999