Submitted to: Gastroenterology
Publication Type: Abstract Only
Publication Acceptance Date: 9/12/2006
Publication Date: 10/3/2006
Citation: Shulman, R.J. 2006. Utility of fecal calprotectin in differentiating inflammatory bowel disease (IBD) from recurrent abdominal pain (RAP) in children [abstract]. Gastroenterology. 130(4):A206-A207. Interpretive Summary:
Technical Abstract: Background: It often is difficult to differentiate IBD from RAP in children. Fecal calprotectin concentration has been proposed as a marker to identify gastrointestinal inflammation and it may be useful in distinguishing organic disease (i.e., IBD) from normals. However, there are scant data regarding its utility in distinguishing IBD from RAP in children. We hypothesized fecal calprotectin concentration would discriminate between IBD, RAP, and Control children without disease. Values in children (as compared to infants) do not change with age. Design/Methods: Children were identified from pediatrician (RAP and Controls) and pediatric gastroenterologist (RAP and IBD) records. Parents were contacted and screened further by phone for eligibility. Children with RAP met Rome II criteria for functional abdominal pain or irritable bowel syndrome. The Pediatric Crohns Disease Activity Index (PCDAI) and the Ulcerative Colitis Clinical Activity Index (UCCAI, BMJ 1989;298:82) were calculated. A random stool was collected for determination of fecal calprotectin concentration. Results: Mean (SD) ages were IBD: 13.6 +/- 2.8 yr. (n = 52); RAP: 8.5 +/- 1.1 (n = 75); Control: 8.7 +/- 1.0 (n = 44). Fecal calprotectin concentration was significantly different among the groups (ANOVA, p < 0.0001) as well as between groups: IBD: 1113 +/- 1009 microg/g stool; RAP: 59 +/- 75; Control: 36 +/- 21; IBD vs RAP or Control, P < 0.001; RAP vs Control, P = 0.021). Fecal calprotectin correlated weakly with the PCDAI (score: 24 +/- 13; P = 0.028, r**2 = 0.11, n = 36) but not for the Clinical Activity Index (score: 4. +/- 3.4; P = 0.1, n = 16). Sensitivity, specificity, positive predictive value, and negative predictive values are shown in the Table (normal < 50 microg/g). Conclusions: Fecal calprotectin concentrations: 1) are elevated in children with IBD and RAP compared with controls; 2) are greater in RAP than controls; 3) appear to be useful as a screening test in children being evaluated for IBD whether they have RAP or not; 4) are somewhat specific for RAP compared with Controls but lack sensitivity and negative predictive value.