A simple method for assessing intestinal inflammation in Crohn's disease

  • Tibble, J
  • Teahon, K
  • Thjodleifsson, B
  • Roseth, A
  • Sigthorsson, G
  • Bridger, S
  • Foster, R
  • Sherwood, R
  • Fagerhol, M
  • Bjarnason, I

  • 1Department of Medicine, Guy's, King's, St Thomas' Medical School, London, UK, 2Department of Gastroenterology, Nottingham City Hospital, Nottingham, UK, 3Department of Medicine, Iceland University Hospital, Reykjavik, Iceland, 4Department of Medicine, Aker University Hospital, Oslo, Norway, 5Department of Immunology and Transfusion, Ullevaal University Hospital, Oslo, Norway, and Aker University Hospital, Oslo, Norway

Accepted for publication 4 April 2000

Correspondence to: Professor I Bjarnason, Department of Medicine, Guy's, King's, St Thomas's Medical School, Bessemer Road, London SE5 9PJ, UK. Email: [email protected]

Dr Tibble was supported by an SE Thames NHS Executive R&D grant.

Gut 47(4):p 506-513, October 1, 2000.

BACKGROUND AND AIMS

Assessing the presence and degree of intestinal inflammation objectively, simply, and reliably is a significant problem in gastroenterology. We assessed faecal excretion of calprotectin, a stable neutrophil specific marker, as an index of intestinal inflammation and its potential use as a screening test to discriminate between patients with Crohn's disease and those with irritable bowel syndrome.

METHODS

The validity of faecal calprotectin as a marker of intestinal inflammation was assessed in 22 patients with Crohn's disease (35 studies) by comparing faecal excretions and concentrations using four day faecal excretion of 111indium white cells. A cross sectional study assessed the sensitivity of faecal calprotectin concentration for the detection of established Crohn's disease (n=116). A prospective study assessed the value of faecal calprotectin in discriminating between patients with Crohn's disease and irritable bowel syndrome in 220 patients referred to a gastroenterology clinic.

RESULTS

Four day faecal excretion of 111indium (median 8.7%; 95% confidence interval (CI) 7–17%; normal <1.0%) correlated significantly (p<0.0001) with daily (median ranged from 39 to 47 mg; normal <3 mg;r =0.76–0.82) and four day faecal calprotectin excretion (median 101 mg; 95% CI 45–168 mg; normal <11 mg;r =0.80) and single stool calprotectin concentrations (median 118 mg/l; 95% CI 36–175 mg/l; normal <10 mg/l;r =0.70) in patients with Crohn's disease. The cross sectional study showed a sensitivity of 96% for calprotectin in discriminating between normal subjects (2 mg/l; 95% CI 2–3 mg/l) and those with Crohn's disease (91 mg/l; 95% CI 59–105 mg/l). With a cut off point of 30 mg/l faecal calprotectin has 100% sensitivity and 97% specificity in discriminating between active Crohn's disease and irritable bowel syndrome.

CONCLUSION

The calprotectin method may be a useful adjuvant for discriminating between patients with Crohn's disease and irritable bowel syndrome.

Copyright © 2000 Gut.