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Slide 1
Ian Arnott Consultant Gastroenterologist Western General
Hospital Edinburgh The Use of Faecal Calprotectin in Primary
Care
Slide 2
MH 30 years female 3/12 history of abdominal pain Right sided
Constipation BOx1/week No weight loss, appetite unchanged No past
medical history Non-smoker
Slide 3
Investigations Full blood count Hb 127 WCC 7.9 Plt 293 USS
normal
Slide 4
Impression ... I think the most likely diagnosis is
constipation predominant irritable bowel syndrome. I would suggest
a trial of laxatives... Ian Arnott BUT Faecal calprotectin >2500
g/g
Slide 5
Colonoscopy
Slide 6
Difficult to differentiate organic from functional symptoms IBD
more common Up to 2% of population in high areas
Slide 7
Delay in diagnosis of IBD is important
Slide 8
Colonoscopy Key diagnostic tool Colorectal cancer Inflammatory
bowel disease Etc etc... BUT patients with IBS do not always need
this Unpleasant Reinforce doubt about diagnosis Resource
intensive
Slide 9
Faecal calprotectin
Slide 10
Faecal Calprotectin: IBD v IBS Henderson et al. AJG 2014
Slide 11
Organic v IBS
Slide 12
Cut off
Lothian Algorithm - Pilot Age less than 50? Alarm symptoms?
Faecal calprotectin, Stool culture, Coeliac screen & FBC
FC150FC 50 - 150 Referral for investigation Functional
diagnosisRepeat calprotectin in 4 6 weeks. Functional diagnosis
likely Consider referral as per current guidance Referral for
urgent investigation Referral for D2 bx or other investigation yes
no
Slide 24
Conclusions Faecal calprotectin can effectively differentiate
between IBS and organic GI conditions Simple to assay Helps select
patients for referral or investigation Cost effective Pilot in
Lothian planned please take part!