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FOCUS: Future of fecal calprotectin utility study in inflammatory bowel disease

View Article: PubMed Central - PubMed

ABSTRACT

Aim: To evaluate the perspective of gastroenterologists regarding the impact of fecal calprotectin (FC) on the management of patients with inflammatory bowel disease (IBD).

Methods: Patients with known IBD or symptoms suggestive of IBD for whom the physician identified that FC would be clinically useful were recruited. Physicians completed an online “pre survey” outlining their rationale for the test. After receipt of the test results, the physicians completed an online “post survey” to portray their perceived impact of the test result on patient management. Clinical outcomes for a subset of patients with follow-up data available beyond the completion of the “post survey” were collected and analyzed.

Results: Of 373 test kits distributed, 290 were returned, resulting in 279 fully completed surveys. One hundred and ninety patients were known to have IBD; 147 (77%) with Crohn’s Disease, 43 (21%) Ulcerative Colitis and 5 (2%) IBD unclassified. Indications for FC testing included: 90 (32.2%) to differentiate a new diagnosis of IBD from Irritable Bowel Syndrome (IBS), 85 (30.5%) to distinguish symptoms of IBS from IBD in those known to have IBD and 104 (37.2%) as an objective measure of inflammation. FC levels resulted in a change in management 51.3% (143/279) of the time which included a significant reduction in the number of colonoscopies (118) performed (P < 0.001). Overall, 97.5% (272/279) of the time, the physicians found the test sufficiently useful that they would order it again in similar situations. Follow-up data was available for 172 patients with further support for the clinical utility of FC provided.

Conclusion: The FC test effected a change in management 51.3% of the time and receipt of the result was associated with a reduction in the number of colonoscopies performed.

No MeSH data available.


Management decisions following fecal calprotectin testing. Proportion of patients for each of the possible management options, A: When the fecal calprotectin (FC) test caused physicians to change the management of their patient (n = 143); B: When the FC test did NOT cause a change in patient management (n = 136).
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Figure 1: Management decisions following fecal calprotectin testing. Proportion of patients for each of the possible management options, A: When the fecal calprotectin (FC) test caused physicians to change the management of their patient (n = 143); B: When the FC test did NOT cause a change in patient management (n = 136).

Mentions: Overall, FC test resulted in a change in management 51.3% of the time (143/279) according to the physician response to the post-survey. Table 1 shows the breakdown of the impact of FC on patient management based on the indication for performing the test, the disease type, the disease location and current treatment. Specific management decisions following receipt of FC test result are shown in Figure 1. When using either a cut-off of 250 or 100 μg/g, patients were significantly more likely to have a change in management when the FC result was positive (250 μg/g, P < 0.0001 (Figure 2)) (100 μg/g, P = 0.0009).


FOCUS: Future of fecal calprotectin utility study in inflammatory bowel disease
Management decisions following fecal calprotectin testing. Proportion of patients for each of the possible management options, A: When the fecal calprotectin (FC) test caused physicians to change the management of their patient (n = 143); B: When the FC test did NOT cause a change in patient management (n = 136).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5037090&req=5

Figure 1: Management decisions following fecal calprotectin testing. Proportion of patients for each of the possible management options, A: When the fecal calprotectin (FC) test caused physicians to change the management of their patient (n = 143); B: When the FC test did NOT cause a change in patient management (n = 136).
Mentions: Overall, FC test resulted in a change in management 51.3% of the time (143/279) according to the physician response to the post-survey. Table 1 shows the breakdown of the impact of FC on patient management based on the indication for performing the test, the disease type, the disease location and current treatment. Specific management decisions following receipt of FC test result are shown in Figure 1. When using either a cut-off of 250 or 100 μg/g, patients were significantly more likely to have a change in management when the FC result was positive (250 μg/g, P < 0.0001 (Figure 2)) (100 μg/g, P = 0.0009).

View Article: PubMed Central - PubMed

ABSTRACT

Aim: To evaluate the perspective of gastroenterologists regarding the impact of fecal calprotectin (FC) on the management of patients with inflammatory bowel disease (IBD).

Methods: Patients with known IBD or symptoms suggestive of IBD for whom the physician identified that FC would be clinically useful were recruited. Physicians completed an online &ldquo;pre survey&rdquo; outlining their rationale for the test. After receipt of the test results, the physicians completed an online &ldquo;post survey&rdquo; to portray their perceived impact of the test result on patient management. Clinical outcomes for a subset of patients with follow-up data available beyond the completion of the &ldquo;post survey&rdquo; were collected and analyzed.

Results: Of 373 test kits distributed, 290 were returned, resulting in 279 fully completed surveys. One hundred and ninety patients were known to have IBD; 147 (77%) with Crohn&rsquo;s Disease, 43 (21%) Ulcerative Colitis and 5 (2%) IBD unclassified. Indications for FC testing included: 90 (32.2%) to differentiate a new diagnosis of IBD from Irritable Bowel Syndrome (IBS), 85 (30.5%) to distinguish symptoms of IBS from IBD in those known to have IBD and 104 (37.2%) as an objective measure of inflammation. FC levels resulted in a change in management 51.3% (143/279) of the time which included a significant reduction in the number of colonoscopies (118) performed (P &lt; 0.001). Overall, 97.5% (272/279) of the time, the physicians found the test sufficiently useful that they would order it again in similar situations. Follow-up data was available for 172 patients with further support for the clinical utility of FC provided.

Conclusion: The FC test effected a change in management 51.3% of the time and receipt of the result was associated with a reduction in the number of colonoscopies performed.

No MeSH data available.