Could fecal calprotectin enter mainstream use for diagnosing and monitoring inflammatory bowel disease?

authors found that the overall accuracy for differentiating IBD from IBS or other types of colitis was 94% and 91% respectively for Quantum Blue ® (cutoff, 50 μg/g); 92% and 89% for EliA TM (cutoff, 50 μg/g); and 82% and 76% for RIDAS-CREEN ® (cutoff, 50 μg/g). The Quantum Blue ® Calprotectin and EliA TM Calprotectin results were significantly correlated with the CDAI (Spearman's rank correlation coefficient r=0.66 and 0.49 respectively) in patients with CD. EliA TM Cal-protectin was significantly correlated with the Mayo score (r=0.70) in UC patients. Thus, the authors concluded that fe-cal calprotectin levels were useful in identifying IBD. Overall, these three fecal calprotectin kits were comparable in accuracy. Although this was a small-scale study, it provided practical and useful information on these three kits. This can help guide our daily clinical practice in terms of choosing an appropriate kit. Their results clearly demonstrated that all three fecal calprotectin kits were superior to CRP in distinguishing IBD from IBS and other types of colitis. In addition, the overall accuracies of these three kits were comparable. However, although there was good correlation between the different kits, it is inappropriate to directly compare the absolute calprotectin levels between the kits. Instead, the same kit should be used for follow-up comparisons. At present, cost appears to be the main factor affecting the choice of kit. The authors noted that the prices range from 20 to 33 US dollars per test, but also explained that the final cost might vary according to the number of tests submitted. When the availability and cost issues have been resolved, we can expect that fecal calprotectin will enter mainstream use for the diagnosis and monitoring of IBD. Calprotectin is a heterodimer of the calcium binding proteins S100A8 and S100A9, and is mainly present in neutro-phils. 1 Fecal calprotectin levels are correlated with the degree of intestinal inflammation, and have been found to increase when neutrophils migrate into the bowel lumen due to the inflammatory process. 2 Therefore, fecal calprotectin could help discriminate between IBD and IBS, 3 monitor treatment response and endoscopic disease activity, 4,5 and predict relapse for IBD. 6 Studies have also shown that fecal calprotectin levels are correlated with endoscopic severity scores 5 and the extent of inflammation in Asian patients with UC. 7 Coupled with the fact that it is a non-invasive and easily accessible test, the use of fecal calprotectin …