Faecal calprotectin testing for identifying patients with organic gastrointestinal disease: systematic review and meta-analysis.
Diagnostic tests and procedures
Inflammatory bowel diseases
Irritable bowel syndrome
Mass screening
Meta-analysis
Systematic review
Journal
The Medical journal of Australia
ISSN: 1326-5377
Titre abrégé: Med J Aust
Pays: Australia
ID NLM: 0400714
Informations de publication
Date de publication:
11 2019
11 2019
Historique:
pubmed:
5
11
2019
medline:
25
2
2020
entrez:
5
11
2019
Statut:
ppublish
Résumé
To assess the clinical effectiveness of faecal calprotectin (FC) testing for distinguishing between organic gastrointestinal diseases (organic GID), such as inflammatory bowel disease (IBD), and functional gastrointestinal disorders (functional GIDs). Studies that assessed the accuracy of FC testing for differentiating between IBD or organic GID and functional GIDs were reviewed. Articles published in English during January 1998 - June 2018 that compared diagnostic FC testing in primary care and outpatient hospital settings with a reference test and employed the standard enzyme-linked immunosorbent FC assay method with a cut-off of 50 or 100 μg/g faeces were included. Study quality was assessed with QUADAS-2, an evidence-based quality assessment tool for diagnostic accuracy studies. MEDLINE and EMBASE; reference lists of screened articles. Eighteen relevant studies were identified. For distinguishing patients with organic GID (including IBD) from those with functional GIDs (16 studies), the estimated sensitivity of FC testing was 81% (95% CI, 74-86%), the specificity 81% (95% CI, 71-88%); area under the curve (AUC) was 0.87. For distinguishing IBD from functional GIDs (ten studies), sensitivity was 88% (95% CI, 80-93%), specificity 72% (95% CI, 59-82%), and AUC 0.89. Assuming a population prevalence of organic GID of 1%, the positive predictive value was 4.2%, the negative predictive value 100%. The difference in sensitivity and specificity between FC testing cut-offs of 50 μg/g and 100 μg/g faeces was not statistically significant (P = 0.77). FC testing is clinically useful for distinguishing organic GID (including IBD) from functional GIDs, and its incorporation into clinical practice for evaluating patients with lower gastrointestinal symptoms could lead to fewer patients with functional GIDs undergoing colonoscopy, reducing costs for both patients and the health system. CRD4201810507.
Substances chimiques
Leukocyte L1 Antigen Complex
0
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
461-467Informations de copyright
© 2019 AMPCo Pty Ltd.
Références
Jones R. Primary care research and clinical practice: gastroenterology. Postgrad Med J 2008; 84: 454-458.
Arasardnam RP, Brown S, Forbes A, et al. Guidelines for the investigation of chronic diarrhoea in adults: British Society of Gastroenterology. Gut 2018; 67: 1380-1399.
Holtmann GJ, Ford AC, Talley NJ. Pathophysiology of irritable bowel syndrome. Lancet Gastroenterol Hepatol 2016; 1: 133-146.
Lovell RM, Ford AC. Global prevalence of and risk factors for irritable bowel syndrome: a meta-analysis. Clin Gastroenterol Hepatol 2012; 10:712-721.e4.
Linedale EC, Andrews JM. Diagnosis and management of irritable bowel syndrome: a guideline for the generalist. Med J Aust 2017; 207: 309-315. https://www.mja.com.au/journal/2017/207/7/diagnosis-and-management-irritable-bowel-syndrome-guide-generalist;
PricewaterhouseCoopers Australia. Improving inflammatory bowel disease care across Australia. Mar 2013. https://www.crohnsandcolitis.com.au/site/wp-content/uploads/PwC-report-2013.pdf (viewed Sept 2018).
Gastroenterological Society of Australia Digestive Health Foundation. Information about irritable bowel syndrome; third edition. 2010. https://cart.gesa.org.au/membes/files/Consumer%20Information/IBS.pdf (viewed Oct 2018).
American College of Gastroenterology Task Force on Irritable Bowel Syndrome; Brandt LJ, Chey WD, Foxx-Orenstein AE, et al. An evidence-based position statement on the management of irritable bowel syndrome. Am J Gastroenterol 2009; 104 (Suppl 1): S1-S35.
National Institute for Health and Care Excellence. Faecal calprotectin diagnostic tests for inflammatory disease of the bowel (Diagnostics guidance DG11). Oct 2013. https://www.nice.org.uk/guidance/dg11 (viewed Oct 2018).
Fukudo S, Kaneko H, Akiho H, et al. Evidence-based clinical practice guidelines for irritable bowel syndrome. J Gastroenterol 2015; 50: 11-30.
Shin JE, Jung HK, Lee TH, et al. Guidelines for the diagnosis and treatment of chronic functional constipation in Korea, 2015 revised edition. J Neurogastroenterol Motil 2016; 22: 383-411.
Carmona-Sánchez R, Icaza-Chávez ME, Bielsa-Fernández MV, et al. The Mexican consensus on irritable bowel syndrome. Rev Gastroenterol Mex 2016; 81: 149-167.
Linedale EC, Shahzad MA, Kellie AR, et al. Referrals to a tertiary hospital: a window into clinical management issues in functional gastrointestinal disorders. JGH Open 2017; 1: 84-91.
Chey WD, Nojkov B, Rubenstein JH, et al. The yield of colonoscopy in patients with non-constipated irritable bowel syndrome: results from a prospective, controlled US trial. Am J Gastroenterol 2010; 105: 859-865.
Rizvi Q, Lindale EC, Mikocka-Walus A, et al. Can we better target colonoscopies using standard “appropriateness” guides? [abstract]. J Gastroenterol Hepatol 2015; 30 (Suppl 3): 58.
Waugh N, Cummins E, Royle P, et al. Faecal calprotectin testing for differentiating amongst inflammatory and non-inflammatory bowel disease: systematic review and economic evaluation. Health Technology Assessment 2013; 17(55).
Jellema P, van Tulder MW, van der Horst HE, et al. Inflammatory bowel disease: a systematic review on the value of diagnostic testing in primary care. Colorectal Dis 2011; 13: 239-254.
Moher D, Liberati A, Tetzlaff J, Altman DG; the PRISMA Group. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement. BMJ 2009; 339: b2535.
Whiting PF, Rutjes AW, Westwood ME, et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med 2011; 155: 529-536.
Macaskill P, Gatsonic C, Deeks JJ, et al. Analysing and presenting results. In: Deeks JJ, Bossuyt PM, Gatsonis C (editors). Cochrane handbook for systematic reviews of diagnostic test accuracy, version 1.0. The Cochrane Collaboration, 2010. https://methods.cochrane.org/sites/methods.cochrane.org.sdt/files/public/uploads/Chapter%2010%20-%20Version%201.0.pdf (viewed Apr 2019).
Glas AS, Lijmer JG, Prins MH, et al. The diagnostic odd ratio: a single indicator of test performance. J Clin Epidemiol 2003; 56: 1129-1135.
DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials 1986; 7: 177-188.
Reitsma JB, Glas AS, Rutjes AW, et al. Bivariate analysis of sensitivity and specificity produces informative summary measures in diagnostic reviews. J Clin Epidemiol 2005; 58: 982-990.
Limburg PJ, Ahlquist DA, Sandborn WJ, et al. Fecal calprotectin levels predict colorectal inflammation among patients with chronic diarrhea referred for colonoscopy. Am J Gastroenterol 2000; 95: 2831-2837.
Carrocio A. Diagnostic accuracy of fecal calprotectin assay in distinguishing organic causes of chronic diarrhea from irritable bowel syndrome: a prospective study in adults and children. Clin Chem 2003; 49: 861-867.
D'Inca R, Dal Pont E, Di Leo V, et al. Calprotectin and lactoferrin in the assessment of intestinal inflammation and organic disease. Int J Colorectal Dis 2007; 22: 429-437.
Otten CM, Kok L, Witterman BJ, et al. Diagnostic performance of rapid tests for detection of fecal calprotectin and lactoferrin and their ability to discriminate inflammatory from irritable bowel syndrome. Clin Chem Lab Med 2008; 46: 1275-1280.
Damms A, Bischoff SC. Validation and clinical significance of a new calprotectin rapid test for the diagnosis of gastrointestinal diseases. Int J Colorectal Dis 2008; 23: 985-992.
Schoepfer AM, Trummler M, Seeholzer P, et al. Discriminating IBD from IBS: comparison of the test performance of fecal markers, blood leukocytes, CRP and IBD antibodies. Inflamm Bowel Dis 2008; 14: 32-39.
El-Badry A, Sedrak H, Rashed L. Faecal calprotectin in differentiating between functional and organic bowel diseases. Arab Journal of Gastroenterology 2010; 11: 70-73.
Kok L, Elias SG, Witteman BJM, et al. Diagnostic accuracy of point-of-care fecal calprotectin and immunochemical occult blood test for diagnosis of organic bowel disease in primary care: the Cost-Effectiveness of a Decision Rule for Abdominal Complaints in Primary Care (CEDAR) study. Clin Chem 2012; 58: 989-998.
Burri E, Manz M, Rothen C, et al. Monoclonal antibody testing for fecal calprotectin is superior to polyclonal testing of fecal calprotectin and lactoferrin to identify organic intestinal disease in patients with abdominal discomfort. Clin Chim Acta 2013; 416: 41-47.
Pavlidis P, Chedgy FJ, Tibble JA. Diagnostic accuracy and clinical application of faecal calprotectin in adult patients presenting with gastrointestinal symptoms in primary care. Scand J Gastroenterol 2013; 48: 1048-1054.
Lozoya Angulo ME, de Las Heras Gómez I, Martinez Villanueva M, et al. Faecal calprotectin, an useful marker in discriminating between inflammatory bowel disease and functional gastrointestinal disorders. Gastroenterol Hepatol 2017; 40: 125-131.
Dhaliwal A, Zeino Z, Tomkins C, et al. Utility of faecal calprotectin in inflammatory bowel disease (IBD): what cut-offs should we apply? Frontline Gastroenterol 2015; 6: 14-19.
Banerjee A, Srinivas M, Eyre R, et al. Faecal calprotectin for differentiating between irritable bowel syndrome and inflammatory bowel disease: a useful screen in daily gastroenterology practice. Frontline Gastroenterol 2015; 6: 20-26.
Turvill J, O'Connell S, Brooks A, et al. Evaluation of a faecal calprotectin care pathway for use in primary care. Prim Health Care Res Dev 2016; 17: 428-436.
Högberg C, Karling P, Rutegård J, Lilja M. Diagnosing colorectal cancer and inflammatory bowel disease in primary care: the usefulness of tests for faecal haemoglobin, faecal calprotectin, anaemia and iron deficiency. A prospective study. Scand J Gastroenterol 2017; 52: 69-75.
Conroy S, Hale MF, Cross SS, et al. Unrestricted faecal calprotectin testing performs poorly in the diagnosis of inflammatory bowel disease in patients in primary care. J Clin Pathol 2018; 71: 316-322.
Walker GJ, Moore L, Heerasing N, et al. Faecal calprotectin effectively excludes inflammatory bowel disease in 789 symptomatic young adults with/without alarm symptoms: a prospective UK primary care cohort study. Aliment Pharmacol Ther 2018; 47: 1103-1116.
Turvill J, Turnock D, Holmes H, et al. Evaluation of the clinical and cost-effectiveness of the York Faecal Calprotectin Care Pathway. Frontline Gastroenterol 2018; 9: 285-294.
Linedale EC, Mikocka-Walus A, Vincent AD, et al. Performance of an algorithm-based approach to the diagnosis and management of functional gastrointestinal disorders: a pilot trial. Neurogastroenterol Motil 2018; 30: e13243.
Linedale EC. Issues in the diagnosis and management of functional gastrointestinal disorders: the development of a novel clinical pathway [thesis]. University of Adelaide, June 2017. https://digital.library.adelaide.edu.au/dspace/bitstream/2440/114587/2/02whole.pdf (viewed Sept 2018).