KT Park - Health economic value of calprotectin testing - A gastroenterologist's perspective

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• Patients presenting with persistent abdominal pain and diarrhea are common in clinical practice. Evaluation of these patients, assuming no alarm symptoms, can be difficult. Inflammatory bowel disease is always a possibility and while few will actually have IBD, the symptoms of IBS and IBD can overlap. Concern with a missed diagnosis of IBD leads many clinicians to request endoscopic evaluation.

• Most endoscopies are negative with over half of endoscopies on individuals with non-bleeding symptoms being diagnosed with non-organic disease, usually IBS.1 Up to 70% of children and teenagers referred to a pediatric gastroenterology center for suspected IBD did not have the disease.2 Furthermore, although endoscopic procedures are relatively common, they are invasive, costly, require patient compliance with fasting and bowel preparation, involve sedation, are subjective.

• The strategy of testing for fecal calprotectin, a calcium and zinc binding protein complex found in neutrophil cytosolic protein, utilizes non-invasive diagnostic testing to stratify patients in need of endoscopic confirmation, reducing costs and improving the overall patient healthcare experience

1. Yang Z, Clark N, and Park KT. Effectiveness and cost-effectiveness of measuring fecal calprotectin in diagnosis of inflammatory bowel disease in adults and children. Clin Gastroenterol Hepatol 2014; 12(2): 253-262.
2. Van de Vijver E, Schreuder A, Cnossen W, Muller K, and van Rheenen P and the North Netherlands Pediatric IBD Consortium. Safely ruling out inflammatory bowel disease in children and teenagers without referral for endoscopy. Arch Dis Child 97:1014-1018.

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