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Open Access Highly Accessed Research article

Value of fecal calprotectin in the evaluation of patients with abdominal discomfort: an observational study

Michael Manz1, Emanuel Burri12, Claude Rothen3, Nuschin Tchanguizi1, Christian Niederberger4, Livio Rossi1, Christoph Beglinger1* and Frank Serge Lehmann1

  • * Corresponding author: Christoph Beglinger beglinger@tmr.ch

  • † Equal contributors

Author Affiliations

1 Department of Gastroenterology, University Hospital of Basel, Petersgraben 4, 4031 Basel, Switzerland

2 Digestive Research Unit, University Hospital Vall d'Hebron, Paseo Vall d'Hebron 119-129, 08035 Barcelona, Spain

3 Rothen Medical Laboratories, Spalengraben 15, 4003 Basel, Switzerland

4 Bühlmann Laboratories AG, Baselstrasse 55, 4124 Schönenbuch, Switzerland

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BMC Gastroenterology 2012, 12:5  doi:10.1186/1471-230X-12-5

Published: 10 January 2012

Abstract

Background

The evaluation of patients with abdominal discomfort is challenging and patient selection for endoscopy based on symptoms is not reliable. We evaluated the diagnostic value of fecal calprotectin in patients with abdominal discomfort.

Methods

In an observational study, 575 consecutive patients with abdominal discomfort referred for endoscopy to the Department of Gastroenterology & Hepatology at the University Hospital Basel in Switzerland, were enrolled in the study. Calprotectin was measured in stool samples collected within 24 hours before the investigation using an enzyme-linked immunosorbent assay. The presence of a clinically significant finding in the gastrointestinal tract was the primary endpoint of the study. Final diagnoses were adjudicated blinded to calprotectin values.

Results

Median calprotectin levels were higher in patients with significant findings (N = 212, median 97 μg/g, IQR 43-185) than in patients without (N = 326, 10 μg/g, IQR 10-23, P < 0.001). The area under the receiver operating characteristics curve (AUC) to identify a significant finding was 0.877 (95% CI, 0.85-0.90). Using 50 μg/g as cut off yielded a sensitivity of 73% and a specificity of 93% with good positive and negative likelihood ratios (10.8 and 0.29, respectively). Fecal calprotectin was useful as a diagnostic parameter both for findings in the upper intestinal tract (AUC 0.730, 0.66-0.79) and for the colon (AUC 0.912, 0.88-0.94) with higher diagnostic precision for the latter (P < 0.001). In patients > 50 years, the diagnostic precision remained unchanged (AUC 0.889 vs. 0.832, P = 0.165).

Conclusion

In patients with abdominal discomfort, fecal calprotectin is a useful non-invasive marker to identify clinically significant findings of the gastrointestinal tract, irrespective of age.

Keywords:
Gastroenterology; Endoscopy; Diagnosis; Biomarker