Observational Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 28, 2016; 22(36): 8211-8218
Published online Sep 28, 2016. doi: 10.3748/wjg.v22.i36.8211
FOCUS: Future of fecal calprotectin utility study in inflammatory bowel disease
Greg Rosenfeld, Astrid-Jane Greenup, Andrew Round, Oliver Takach, Lawrence Halparin, Abid Saadeddin, Jin Kee Ho, Terry Lee, Robert Enns, Brian Bressler
Greg Rosenfeld, Astrid-Jane Greenup, Andrew Round, Oliver Takach, Lawrence Halparin, Robert Enns, Brian Bressler, Department of Medicine, Division of Gastroenterology, St. Paul’s Hospital, University of British Columbia, Vancouver, BC V6Z 2K5, Canada
Abid Saadeddin, Department of Medicine, Division of Gastroenterology, Prince George Regional Hospital, University of British Columbia, Vancouver, BC V6Z 2K5, Canada
Jin Kee Ho, Department of Medicine, Division of Gastroenterology, Lion’s Gate Hospital, University of British Columbia, Vancouver, BC V6Z 2K5, Canada
Terry Lee, Centre for Health Evaluation and Outcome Sciences, St Paul’s Hospital, Vancouver, BC V6Z 2K5, Canada
Author contributions: Rosenfeld G, Greenup AJ, Round A and Lee T analyzed the data; Rosenfeld G, Greenup AJ and Bressler B drafted the manuscript; Rosenfeld G and Round A provided study supervision; Rosenfeld G, Round A, Takach O, Saadeddin A, Ho JK, Enns R and Bressler B provided administrative support; Rosenfeld G and Bressler B designed the research; Round A, Halparin L, Saadeddin A, Ho JK, Enns R and Bressler B provided data acquisition; and Halparin L, Enns R and Bressler B critically revised the manuscript.
Institutional review board statement: The study was reviewed and approved by Providence Health Care and the University of British Columbia research ethics board.
Informed consent statement: All study participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement: Bressler B: Advisory Board (Abbvie, Janssen, Takeda, Shire, Genentech, Ferring, Pfizer). Speaker’s Bureau (Abbvie, Janssen, Takeda, Shire). Consultant (Celltrion, Pendopharm, Allergan). Research Support (Abbvie, Amgen, Takeda, BMS, Genentech, Janssen, BI, GSK, Redhill Biopharm, Celgene). Stock Options (Qu Biologics). Other authors declared no conflict of interest related to this study.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Greg Rosenfeld, MD, MHSc, FRCPC, CCFP, Clinical Assistant Professor, Department of Medicine, Division of Gastroenterology, St. Paul’s Hospital, University of British Columbia, 770 - 1190 Hornby Street, Vancouver, BC V6Z 2K5, Canada. greg.rosenfeld@me.com
Telephone: +1-60-46886332 Fax: +1-60-46892004
Received: May 11, 2016
Peer-review started: May 13, 2016
First decision: June 20, 2016
Revised: July 24, 2016
Accepted: August 23, 2016
Article in press: August 23, 2016
Published online: September 28, 2016
Processing time: 137 Days and 18.7 Hours
Abstract
AIM

To evaluate the perspective of gastroenterologists regarding the impact of fecal calprotectin (FC) on the management of patients with inflammatory bowel disease (IBD).

METHODS

Patients with known IBD or symptoms suggestive of IBD for whom the physician identified that FC would be clinically useful were recruited. Physicians completed an online “pre survey” outlining their rationale for the test. After receipt of the test results, the physicians completed an online “post survey” to portray their perceived impact of the test result on patient management. Clinical outcomes for a subset of patients with follow-up data available beyond the completion of the “post survey” were collected and analyzed.

RESULTS

Of 373 test kits distributed, 290 were returned, resulting in 279 fully completed surveys. One hundred and ninety patients were known to have IBD; 147 (77%) with Crohn’s Disease, 43 (21%) Ulcerative Colitis and 5 (2%) IBD unclassified. Indications for FC testing included: 90 (32.2%) to differentiate a new diagnosis of IBD from Irritable Bowel Syndrome (IBS), 85 (30.5%) to distinguish symptoms of IBS from IBD in those known to have IBD and 104 (37.2%) as an objective measure of inflammation. FC levels resulted in a change in management 51.3% (143/279) of the time which included a significant reduction in the number of colonoscopies (118) performed (P < 0.001). Overall, 97.5% (272/279) of the time, the physicians found the test sufficiently useful that they would order it again in similar situations. Follow-up data was available for 172 patients with further support for the clinical utility of FC provided.

CONCLUSION

The FC test effected a change in management 51.3% of the time and receipt of the result was associated with a reduction in the number of colonoscopies performed.

Keywords: Inflammatory bowel disease; Biomarkers; Fecal calprotectin; Colonoscopy; Physician perspective

Core tip: Fecal calprotectin (FC) is a biomarker that provides a method of non-invasive assessment for intestinal inflammation. We evaluated the perspective of a group of gastroenterologists regarding the clinical use of FC, in particular the impact it has on the management of patients with inflammatory bowel disease (IBD). Patients with suspected or known IBD were recruited for study participation. A “pre survey” and “post survey” were completed by the physician prior to and after receipt of the FC result respectively. Of the 279 FC and surveys completed, FC levels resulted in a change in management 51.3% of the time and resulted in a significant reduction in colonoscopies performed.