Fecal calprotectin: A selection tool for small bowel capsule endoscopy in suspected IBD with prior negative bi-directional endoscopy
Fecal calprotectin: A selection tool for small bowel capsule endoscopy in suspected IBD with prior negative bi-directional endoscopy
复制标题
DOI：
10.3109/00365521.2011.551835
复制
发表时间：
2011-05-01
影响因子：
1.9
通讯作者：
Plevris, John N.
中科院分区：
文献类型：
--
作者：
Koulaouzidis, Anastasios;Douglas, Sarah;Plevris, John N.
背景和目标。粪便钙卫蛋白（FC）是胃肠道炎症的非侵入性标志物，在区分炎症性肠病（IBD）和非IBD诊断方面具有提倡的诊断精度。FC与小肠钡剂放射学异常相关，但与小肠胶囊式内窥镜（SBCE）相关的数据很少。在双向内镜检查阴性但临床上持续怀疑克罗恩病（CD）的患者队列中，研究FC作为SBCE小肠进一步研究的选择工具的价值。方法.我们回顾性地将SBCE的结果与临床怀疑CD和双向内窥镜检查阴性的患者的FC水平相关联。仅纳入SBCE检测前具有FC结果的患者;在多次FC测定的情况下，选择最接近SBCE日期的值。所有患者的用药史包括阿司匹林或非甾体抗炎药（NSAID）的使用。SBCE结果与最终诊断和FC值进行了分析。结果研究了70例成人患者（53例女性，17例男性）。3例病例因胶囊滞留在胃中而被排除。从FC测量到SBCE的中位时间为62天。23例FC正常（<千分之一货币符号50 μ g/g），SBCE均正常。44名患者的FC > 50 μ μ g/g;在该组中，9名患者的FC在51和100 μ g/g之间，所有患者的SBCE均正常。35例患者的FC水平> 100 μ g/g;其中15例（42.85%）的SBCE结果与CD一致，平均FC水平为326 μ g/g（范围116- 1430 μ g/g）。根据后续随访，10/35例（28.5%）患者被明确诊断为CD。这10例患者属于SBCE阳性结果的15例患者亚组，中位FC水平为368 μ μ g/g（范围为235- 1430 μ g/g）。结论.在转诊进行SBCE之前测量FC水平是选择可能患有小肠CD的患者的有用工具。FC > 100 μ μ g/g是阳性SBCE结果的良好预测因子，而FC > 200 μ μ g/g与较高的SBCE产量（65%）和50%病例中的确诊CD相关。FC在50和100 μ μ g/g之间的患者SBCE正常，尽管症状提示IBD。在所有临床怀疑CD和双向内镜检查阴性的患者中，应在转诊进行SBCE之前进行FC评估。当FC < 100 μ μ g/g（NPV 1.0）时，不显示SBCE。
Background and aim. Fecal calprotectin (FC) is a non-invasive marker of gastrointestinal inflammation with advocated diagnostic precision in distinguishing inflammatory bowel disease (IBD) from non-IBD diagnoses. FC correlates with abnormalities seen on small bowel barium radiology, but little data exist in relation with small bowel capsule endoscopy (SBCE). To investigate the value of FC as a selection tool for further investigation of the small bowel with SBCE, in a cohort of patients who had negative bi-directional endoscopies, but with continuing clinical suspicion of Crohn's disease (CD). Methods. We retrospectively correlated the findings of SBCE with FC levels in patients referred with clinical suspicion of CD and negative bi-directional endoscopies. Only patients with FC results prior to the SBCE test were included; in cases of multiple FC determinations, the value closest to the SBCE date was selected. Medications history including usage of aspirin or non-steroidal anti-inflammatory drugs (NSAIDs) was made available for all patients. SBCE findings were analyzed against final diagnosis and FC values. Results. Seventy adult patients were studied (53 females, 17 males). Three cases were excluded, due to capsule retention in the stomach. Median time from FC measurement to SBCE was 62 days. Twenty-three patients had normal FC (< a parts per thousand currency sign50 mu mu g/g) and in all those the SBCE was normal. Forty-four patients had FC > 50 mu mu g/g; in this group, nine patients had FC between 51 and 100 mu mu g/g and all had a normal SBCE. Thirty-five patients had FC levels > 100 mu mu g/g; of those, 15 (42.85%) had SBCE findings compatible with CD and mean FC levels 326 mu mu g/g (range 116--1430 mu mu g/g). A definitive clinical diagnosis of CD, based on subsequent follow-up, was made in 10/35 (28.5%) of patients. These 10 patients were within the subgroup of 15 patients with positive SBCE findings and had median FC levels 368 mu mu g/g (range 235--1430 mu mu g/g). Conclusions. Measurement of FC levels prior to referral for SBCE is a useful tool to select patients with possible small bowel CD. A FC > 100 mu mu g/g is good predictor of positive SBCE findings, while FC > 200 mu mu g/g was associated with higher SBCE yield (65%) and confirmed CD in 50% of cases. Patients with FC between 50 and 100 mu mu g/g had normal SBCE, despite symptoms suggestive of IBD. In all patients with clinical suspicion of CD and negative bi-directional endoscopies, FC assessment should be carried out prior to their referral for SBCE. Where FC is < 100 mu mu g/g (NPV 1.0), SBCE is not indicated.