Geoffrey M. Forbes, MBBS, MD, FRACP
In patients with suspected inflammatory bowel disease (IBD), what is the accuracy of screening with fecal calprotectin testing?
Included studies assessed the diagnostic accuracy of fecal calprotectin testing in patients with suspected IBD and used prospectively collected data, with the index test (stool sampling) done before the reference standard (endoscopic evaluation, including histopathologic verification of segmental biopsies). Outcomes included sensitivity and specificity of fecal calprotectin testing.
MEDLINE and EMBASE/Excerpta Medica were searched up to October 2009 for English-language studies; reference lists of identified studies were checked. 13 studies (n =1041) met the selection criteria; 6 included adults (n = 670, age range 16 to 88 y), and 7 included children (n = 371, age range 10 mo to 20 y). 9 studies (n = 589) met ≥ 5 of 7 selected items from the Quality Assessment of studies of Diagnostic Accuracy included in Systematic reviews checklist. Methodological quality of studies in children was better than that of studies in adults.
The test characteristics are shown in the Table. Specificity of calprotectin was lower in studies of children compared with studies of adults (P = 0.048). Based on a pretest probability of 32% in adults, an abnormal calprotectin test result would increase the posttest probability to 91% (95% CI 77 to 97), and a normal result would reduce the probability to 3% (CI 1 to 11). Based on a pretest probability of 61% in children, an abnormal test result would increase the posttest probability to 86% (CI 78 to 92) and a normal result would reduce the probability to 15% (CI 7 to 28).
In adults with suspected inflammatory bowel disease, screening with fecal calprotectin has high sensitivity and specificity; sensitivity is similar in children, but specificity is lower.
Test characteristics of fecal calprotectin for screening for suspected inflammatory bowel disease (IBD)*
*Diagnostic terms defined in Glossary. Fecal calprotectin cutpoints ranged from 24 to 150 µg/g; 7 studies used a cutpoint of 50 µg/g.
†LRs calculated on the basis of pooled sensitivity and specificity.
‡Specificity was lower for children than adults (P = 0.048).
Forbes GM. Review: Fecal calprotectin is accurate for screening for suspected IBD in adults but less so in children. Ann Intern Med. 2011;154:JC1–12. doi: 10.7326/0003-4819-154-2-201101180-02012
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Published: Ann Intern Med. 2011;154(2):JC1-12.
Gastroenterology/Hepatology, Inflammatory Bowel Disease.
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