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Daniel R. Gaya - One of the best experts on this subject based on the ideXlab platform.
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Practical guidance on the use of Faecal Calprotectin
Frontline gastroenterology, 2017Co-Authors: Matthew J. Brookes, Daniel R. Gaya, S Whitehead, A. B. HawthorneAbstract:Differentiation between inflammatory bowel disease (IBD) and functional gut disorders, and the determination of mucosal disease activity in established cases of IBD remain the cornerstones of disease diagnosis and management. Non-invasive, accurate biomarkers of gut inflammation are needed due to the variability of symptoms, the inaccuracies of currently available blood markers and the cost and invasive nature of endoscopy. Numerous biomarkers have been used and/or considered with some in current use. This article reviews the current evidence base around the indications for using biomarkers and their limitations, with a particular focus on Faecal Calprotectin.
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A prospective single‐centre evaluation of the intra‐individual variability of Faecal Calprotectin in quiescent Crohn's disease
Alimentary pharmacology & therapeutics, 2013Co-Authors: Graham Naismith, Lyn A. Smith, Sarah Barry, Joanna Munro, Susan Laird, Karen Rankin, Allan J. Morris, J W Winter, Daniel R. GayaAbstract:Summary Background As a non-invasive marker of gastrointestinal inflammation, Faecal Calprotectin (FC) is being increasingly used to guide the management of Crohn's disease. It is therefore a concern that studies have shown variability in day to day levels. Aim To determine the degree of this intrapersonal variability in the context of quiescent Crohn's disease. Methods A single-centre prospective study was undertaken in 143 Crohn's disease patients in clinical remission. Three Faecal Calprotectin levels were analysed from stool samples on consecutive days. Consistency of Faecal Calprotectin levels was determined by measuring the intraclass correlation (ICC). Due to higher variability at higher Faecal Calprotectin levels, the ICC was calculated for the log-transformed values. The reliability of detecting a ‘case’ of active inflammation as defined for specific concentrations of Faecal Calprotectin was measured by the kappa statistic. Results Ninety-eight complete sets of results were obtained. The ICC was 0.84 (95% CI: 0.79–0.89), which represents low variability across samples. The kappa statistic for the reliability of detecting a case as defined by an FC level of >50 μg/g was substantial at 0.648 (0.511–0.769). Conclusions Day to day variability of Faecal Calprotectin is low in our cohort of quiescent Crohn's disease patients and the reliability of defining a ‘case’ is moderately good. These data provide reassurance to clinicians using a single Calprotectin sample to inform therapeutic strategies in this cohort.
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a prospective single centre evaluation of the intra individual variability of Faecal Calprotectin in quiescent crohn s disease
Alimentary Pharmacology & Therapeutics, 2013Co-Authors: Graham Naismith, Lyn A. Smith, Sarah Barry, Joanna Munro, Susan Laird, Karen Rankin, Allan J. Morris, J Winter, Daniel R. GayaAbstract:BACKGROUND: As a non-invasive marker of gastrointestinal inflammation, Faecal Calprotectin (FC) is being increasingly used to guide the management of Crohn's disease. It is therefore a concern that studies have shown variability in day to day levels. AIM: To determine the degree of this intrapersonal variability in the context of quiescent Crohn's disease. METHODS: A single-centre prospective study was undertaken in 143 Crohn's disease patients in clinical remission. Three Faecal Calprotectin levels were analysed from stool samples on consecutive days. Consistency of Faecal Calprotectin levels was determined by measuring the intraclass correlation (ICC). Due to higher variability at higher Faecal Calprotectin levels, the ICC was calculated for the log-transformed values. The reliability of detecting a 'case' of active inflammation as defined for specific concentrations of Faecal Calprotectin was measured by the kappa statistic. RESULTS: Ninety-eight complete sets of results were obtained. The ICC was 0.84 (95% CI: 0.79-0.89), which represents low variability across samples. The kappa statistic for the reliability of detecting a case as defined by an FC level of >50 μg/g was substantial at 0.648 (0.511-0.769). CONCLUSIONS: Day to day variability of Faecal Calprotectin is low in our cohort of quiescent Crohn's disease patients and the reliability of defining a 'case' is moderately good. These data provide reassurance to clinicians using a single Calprotectin sample to inform therapeutic strategies in this cohort.
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Utility of Faecal Calprotectin analysis in adult inflammatory bowel disease
World journal of gastroenterology, 2012Co-Authors: Lyn A. Smith, Daniel R. GayaAbstract:The inflammatory bowel diseases (IBD), Crohn’s disease and ulcerative colitis, are chronic relapsing, remitting disorders. Diagnosis, along with assessment of disease activity and prognosis present challenges to managing clinicians. Faecal biomarkers, such as Faecal Calprotectin, are a non-invasive method which can be used to aid these decisions. Calprotectin is a calcium and zinc binding protein found in the cytosol of human neutrophils and macrophages. It is released extracellularly in times of cell stress or damage and can be detected within faeces and thus can be used as a sensitive marker of intestinal inflammation. Faecal Calprotectin has been shown to be useful in the diagnosis of IBD, correlates with mucosal disease activity and can help to predict response to treatment or relapse. With growing evidence supporting its use, over the last decade this Faecal biomarker has significantly changed the way IBD is managed.
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Faecal Calprotectin: a bright future for assessing disease activity in Crohn's disease.
QJM : monthly journal of the Association of Physicians, 2002Co-Authors: Daniel R. Gaya, J.f. MackenzieAbstract:Calprotectin is a calcium‐binding protein with in vitro bacteriostatic and fungistatic properties. It is found in abundance in neutrophils, where it accounts for 60% of the protein in the cytosol; lower concentrations are found in monocytes and reactive macrophages. It was hoped that measurement of Faecal Calprotectin would represent a surrogate marker of neutrophil influx into the bowel lumen and in turn act as a marker of intestinal inflammation. Studies to date support this hypothesis; increased levels of Faecal Calprotectin are found in inflammatory bowel disease,1,,2 colonic cancer3 and non‐steroidal anti‐inflammatory drug (NSAID) treatment,4,,5 suggesting it is a sensitive but non‐specific marker of intestinal inflammation. Clinical assessment of disease activity and laboratory indices of inflammation correlate poorly with endoscopic findings and histology in patients with inflammatory bowel disease.6 Faecal Calprotectin, however, correlates well with endoscopic and histological grading of disease activity in ulcerative colitis.7 Moreover, it correlates more closely to histology than to macroscopic (colonoscopic) findings,8 suggesting it is more sensitive than endoscopy in inflammatory bowel disease. Assessment of disease activity in ulcerative colitis is amenable to colonoscopic examination and …
Christoph Beglinger - One of the best experts on this subject based on the ideXlab platform.
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IBD: Faecal Calprotectin testing--the need for better standardization.
Nature reviews. Gastroenterology & hepatology, 2014Co-Authors: Emanuel Burri, Christoph BeglingerAbstract:Measurement of Faecal Calprotectin concentration is increasingly used to assess disease activity in patients with IBD. Lasson et al. have now demonstrated that Calprotectin concentrations in faeces of patients with mild or moderate left-sided or extensive ulcerative colitis vary considerably and have questioned the long-term stability of Calprotectin when stored at room temperature.
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Diagnostic yield of endoscopy in patients with abdominal complaints: incremental value of Faecal Calprotectin on guidelines of appropriateness.
BMC gastroenterology, 2014Co-Authors: Emanuel Burri, Christoph Beglinger, Michael Manz, Patricia Schroeder, Florian Froehlich, Livio Rossi, Frank Serge LehmannAbstract:Background European Panel on the Appropriateness of Gastrointestinal Endoscopy (EPAGE) criteria have been developed to increase diagnostic yield, but their predictive value is limited. We investigated the incremental diagnostic value of Faecal Calprotectin to EPAGE criteria.
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Faecal Calprotectin -- a useful tool in the management of inflammatory bowel disease.
Swiss medical weekly, 2012Co-Authors: Emanuel Burri, Christoph BeglingerAbstract:Summary Inflammatory bowel disease (IBD) should be suspected in any patient presenting with chronic or recurrent abdominal pain and diarrhoea. Current guidelines suggest performing invasive endoscopy with histological sampling for further diagnosis. Measuring Calprotectin, a neutrophilic protein, in faeces has been proposed as a surrogate marker of intestinal inflammation. Calprotectin values have been shown to reliably differentiate between IBD and non-organic disease in symptomatic patients and, when elevated, warrant early endoscopic investigation to rule out IBD and other organic pathologies. Endoscopy with histological sampling is also used to evaluate disease activity and here, too, Faecal Calprotectin values seem to correlate well. In a number of studies, Faecal Calprotectin values have consistently shown to better assess mucosal inflammation than clinical indices and serum markers. Calprotectin’s advantage of non-invasive monitoring of disease activity is especially beneficial when considering the dynamics of repeated measurements. Mucosal healing (MH) has been associated with sustained clinical remission, reduced rates of hospitalisation and of surgical resection, both in Crohn’s disease and ulcerative colitis patients. Elevated Faecal Calprotectin levels in patients in clinical remission are associated with increased risk of disease relapse within 12 months follow-up. In most clinically quiescent IBD, residual mucosal inflammation is still present; it appears that Faecal Calprotectin can detect subclinical mucosal inflammation and thus might identify patients at risk for relapse. In summary, measuring Faecal Calprotectin can be highly useful in the diagnosis and disease management of patients with IBD and could help predict disease course.
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Faecal Calprotectin in the diagnosis of inflammatory bowel disease.
Biochemia medica, 2011Co-Authors: Emanuel Burri, Christoph BeglingerAbstract:Suspicion of inflammatory bowel disease should be raised in any patient with chronic or recurrent abdominal pain and diarrhoea. However, symptoms of inflammatory bowel disease (IBD) overlap with functional gastrointestinal disorders and those patients may not need endoscopy. Currently, colonoscopy with multiple biopsies is considered the gold standard to establish the diagnosis of IBD. Unfortunately, patient selection for endoscopy based on symptoms is not reliable. The use of guidelines of appropriateness for endoscopy yields significantly more significant findings but the selection criteria suffer from low specificity. Calprotectin is a calcium binding protein of neutrophil granulocytes that correlates well with neutrophil infiltration of the intestinal mucosa when measured in faeces. In the last decade, a large body of evidence on the diagnostic value of Faecal Calprotectin has accumulated and measurement of Calprotectin in faeces has been suggested as a surrogate marker of intestinal inflammation. Testing of Faecal Calprotectin has been highly useful to distinguish organic from functional intestinal disorders in patients with abdominal complaints. Additionally, Faecal Calprotectin has reliably identified colonic inflammation in patients with suspected IBD. The use of this inexpensive and widely available test in the evaluation and risk stratification in patients with abdominal complaints is likely to increase in the future.
Emanuel Burri - One of the best experts on this subject based on the ideXlab platform.
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The Vampire Study: Significant elevation of Faecal Calprotectin in healthy volunteers after 300 ml blood ingestion mimicking upper gastrointestinal bleeding.
United European gastroenterology journal, 2018Co-Authors: Stephan R. Vavricka, Emanuel Burri, Henriette Heinrich, Simon Buetikofer, Flavia Breitenmoser, Xiaoye Schneider-yin, Jasmin Barman-aksoezen, Luc Biedermann, Michael Scharl, Jonas ZeitzAbstract:BackgroundFaecal Calprotectin correlates with histological and clinical activity in inflammatory bowel disease. Gastrointestinal bleeding might also increase Faecal Calprotectin levels, erroneously...
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IBD: Faecal Calprotectin testing--the need for better standardization.
Nature reviews. Gastroenterology & hepatology, 2014Co-Authors: Emanuel Burri, Christoph BeglingerAbstract:Measurement of Faecal Calprotectin concentration is increasingly used to assess disease activity in patients with IBD. Lasson et al. have now demonstrated that Calprotectin concentrations in faeces of patients with mild or moderate left-sided or extensive ulcerative colitis vary considerably and have questioned the long-term stability of Calprotectin when stored at room temperature.
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Diagnostic yield of endoscopy in patients with abdominal complaints: incremental value of Faecal Calprotectin on guidelines of appropriateness.
BMC gastroenterology, 2014Co-Authors: Emanuel Burri, Christoph Beglinger, Michael Manz, Patricia Schroeder, Florian Froehlich, Livio Rossi, Frank Serge LehmannAbstract:Background European Panel on the Appropriateness of Gastrointestinal Endoscopy (EPAGE) criteria have been developed to increase diagnostic yield, but their predictive value is limited. We investigated the incremental diagnostic value of Faecal Calprotectin to EPAGE criteria.
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Faecal Calprotectin -- a useful tool in the management of inflammatory bowel disease.
Swiss medical weekly, 2012Co-Authors: Emanuel Burri, Christoph BeglingerAbstract:Summary Inflammatory bowel disease (IBD) should be suspected in any patient presenting with chronic or recurrent abdominal pain and diarrhoea. Current guidelines suggest performing invasive endoscopy with histological sampling for further diagnosis. Measuring Calprotectin, a neutrophilic protein, in faeces has been proposed as a surrogate marker of intestinal inflammation. Calprotectin values have been shown to reliably differentiate between IBD and non-organic disease in symptomatic patients and, when elevated, warrant early endoscopic investigation to rule out IBD and other organic pathologies. Endoscopy with histological sampling is also used to evaluate disease activity and here, too, Faecal Calprotectin values seem to correlate well. In a number of studies, Faecal Calprotectin values have consistently shown to better assess mucosal inflammation than clinical indices and serum markers. Calprotectin’s advantage of non-invasive monitoring of disease activity is especially beneficial when considering the dynamics of repeated measurements. Mucosal healing (MH) has been associated with sustained clinical remission, reduced rates of hospitalisation and of surgical resection, both in Crohn’s disease and ulcerative colitis patients. Elevated Faecal Calprotectin levels in patients in clinical remission are associated with increased risk of disease relapse within 12 months follow-up. In most clinically quiescent IBD, residual mucosal inflammation is still present; it appears that Faecal Calprotectin can detect subclinical mucosal inflammation and thus might identify patients at risk for relapse. In summary, measuring Faecal Calprotectin can be highly useful in the diagnosis and disease management of patients with IBD and could help predict disease course.
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Faecal Calprotectin in the diagnosis of inflammatory bowel disease.
Biochemia medica, 2011Co-Authors: Emanuel Burri, Christoph BeglingerAbstract:Suspicion of inflammatory bowel disease should be raised in any patient with chronic or recurrent abdominal pain and diarrhoea. However, symptoms of inflammatory bowel disease (IBD) overlap with functional gastrointestinal disorders and those patients may not need endoscopy. Currently, colonoscopy with multiple biopsies is considered the gold standard to establish the diagnosis of IBD. Unfortunately, patient selection for endoscopy based on symptoms is not reliable. The use of guidelines of appropriateness for endoscopy yields significantly more significant findings but the selection criteria suffer from low specificity. Calprotectin is a calcium binding protein of neutrophil granulocytes that correlates well with neutrophil infiltration of the intestinal mucosa when measured in faeces. In the last decade, a large body of evidence on the diagnostic value of Faecal Calprotectin has accumulated and measurement of Calprotectin in faeces has been suggested as a surrogate marker of intestinal inflammation. Testing of Faecal Calprotectin has been highly useful to distinguish organic from functional intestinal disorders in patients with abdominal complaints. Additionally, Faecal Calprotectin has reliably identified colonic inflammation in patients with suspected IBD. The use of this inexpensive and widely available test in the evaluation and risk stratification in patients with abdominal complaints is likely to increase in the future.
Bjorn Moum - One of the best experts on this subject based on the ideXlab platform.
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Faecal Calprotectin levels differentiate intestinal from pulmonary tuberculosis an observational study from southern india
United European gastroenterology journal, 2014Co-Authors: Geir Larsson, Koticherry Thrivikrama Shenoy, Ramalingom Ramasubramanian, Lakshmikanthan Thayumanavan, Leena Kondarappassery Balakumaran, Gunnar Bjune, Bjorn MoumAbstract:Background: Current methods to establish the diagnosis of intestinal tuberculosis are inadequate. Objectives: We aimed to determine the clinical features of intestinal tuberculosis and evaluate inflammatory biomarkers in intestinal as well as pulmonary tuberculosis. Methods: We recruited 38 intestinal tuberculosis patients, 119 pulmonary tuberculosis patients and 91 controls with functional gastrointestinal disorders between October 2009 and July 2012 for the investigation of clinical features, C-reactive protein (CRP), Faecal and serum Calprotectin. Faecal Calprotectin � 200mg/g was used as a cut-off to determine intestinal inflammation of clinical significance. Three patient categories were established: (a) pulmonary tuberculosis and Faecal Calprotectin <200mg/g (isolated pulmonary tuberculosis); (b) pulmonary tuberculosis and Faecal Calprotectin � 200mg/g (combined pulmonary and intestinal tuberculosis); (c) isolated intestinal tuberculosis. Results: Common clinical features of intestinal tuberculosis were abdominal pain, fatigue, weight loss and watery diarrhoea. Intestinal tuberculosis patients had elevated median CRP (10.7mg/l), Faecal Calprotectin (320mg/g) and serum Calprotectin (5.7mg/ml). Complete normalisation of CRP (1.0mg/L), Faecal Calprotectin (16mg/g) and serum Calprotectin (1.4mg/ml)) was seen upon clinical remission. Patients with combined pulmonary and intestinal tuberculosis had the highest levels of CRP (53.8mg/l) and serum Calprotectin (6.5mg/ml) and presented with signs of more severe disease. Conclusion: Calprotectin analysis reveals intestinal tuberculosis in patients with pulmonary tuberculosis and pinpoints those in need of rigorous follow-up.
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Faecal Calprotectin levels differentiate intestinal from pulmonary tuberculosis: An observational study from Southern India.
United European gastroenterology journal, 2014Co-Authors: Geir Larsson, Koticherry Thrivikrama Shenoy, Ramalingom Ramasubramanian, Lakshmikanthan Thayumanavan, Leena Kondarappassery Balakumaran, Gunnar Bjune, Bjorn MoumAbstract:Background: Current methods to establish the diagnosis of intestinal tuberculosis are inadequate. Objectives: We aimed to determine the clinical features of intestinal tuberculosis and evaluate inflammatory biomarkers in intestinal as well as pulmonary tuberculosis. Methods: We recruited 38 intestinal tuberculosis patients, 119 pulmonary tuberculosis patients and 91 controls with functional gastrointestinal disorders between October 2009 and July 2012 for the investigation of clinical features, C-reactive protein (CRP), Faecal and serum Calprotectin. Faecal Calprotectin � 200mg/g was used as a cut-off to determine intestinal inflammation of clinical significance. Three patient categories were established: (a) pulmonary tuberculosis and Faecal Calprotectin
Gian Lodovico Rapaccini - One of the best experts on this subject based on the ideXlab platform.
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Faecal Calprotectin assay after induction with anti tumour necrosis factor α agents in inflammatory bowel disease prediction of clinical response and mucosal healing at one year
Digestive and Liver Disease, 2014Co-Authors: Luisa Guidi, Manuela Marzo, Gianluca Andrisani, Carla Felice, D Pugliese, Giammarco Mocci, Olga Maria Nardone, Italo De Vitis, Alfredo Papa, Gian Lodovico RapacciniAbstract:a b s t r a c t Background: Faecal Calprotectin levels correlate with inflammation in inflammatory bowel disease. We evaluated the role of Faecal Calprotectin after anti-Tumour Necrosis Factor induction in inflammatory bowel disease patients to predict therapeutic effect at one year. Methods: Faecal Calprotectin levels were measured in stools of 63 patients before and after induction of anti-Tumour Necrosis Factor therapy. Clinical activity, measured by clinical indices, was assessed before and after biologic treatment. Clinical responders after induction were included in the study and colonoscopy was performed before and after one year of treatment to assess mucosal healing. Results: 63 patients (44 Crohn's disease, 19 ulcerative colitis) were prospectively included (41.2% males, mean age at diagnosis 33 years). A sustained clinical response during the first year was observed in 57% of patients; median Faecal Calprotectin was 106 g/g after induction versus 308 g/g pre- induction (p < 0.0001). Post-induction Faecal Calprotectin was significantly lower in responders versus non-responders (p = 0.0002). Post-induction Faecal Calprotectin had 83% sensitivity and 74% specificity (cut-off ≤168 g/g) for predicting a sustained clinical response at one year (p = 0.0001); also, sensitivity was 79% and specificity 57% (cut-off ≤121 g/g) for predicting mucosal healing (p = 0.0001). Conclusions: In inflammatory bowel disease Faecal Calprotectin assay after anti-Tumour Necrosis Factor induction can be used as a marker to predict sustained clinical response and mucosal healing at one year.
