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!

Slide 25

ian.arnott@luht.scot.nhs.uk