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NICE recommends stool test to help diagnose serious bowel conditions

GPs should use faecal calprotectin testing to confirm a diagnosis of irritable bowel syndrome (IBS) and rule out more serious inflammatory bowel diseases, NICE has recommended

Draft guidance from NICE advocates the use of the stool test that it said could reduce the misdiagnosis of bowel disorders in adults and children - such as such as ulcerative colitis and Crohn’s disease - and save the NHS money.

The test should be used to help diagnose inflammatory bowel diseases, and indicate whether a referral to a specialist for further investigation is needed. However, the guidance does not apply to people who are being considered for referral for suspected cancer as inflammatory markers are also present in bowel cancer.

NICE said that the test could help pick up inflammatory bowel disease (IBD) that can lead to serious complications such as surgery and a reduced life expectancy.

The guidance said: ‘Faecal calprotectin testing is recommended as an option in adults with lower gastrointestinal symptoms for whom specialist investigations are being considered, if cancer is not suspected, it is used to support a diagnosis of IBD or IBS, andappropriate quality assurance processes are in place for the testing.’

It added that the test is recommended in children with suspected IBD who have been referred for specialist investigation, to support a diagnosis of IBD.

NICE’s evaluation looked at the different technologies to diagnose IBD and found that faecal calprotectin test was estimated to cost £22.79 per patient, while a colonoscopy- an invasive surgery which can also help diagnose inflammatory bowel disease- was estimated to cost £741.68 per person.

Cost included the cost of the different tests, treatment costs, resource costs such as staff time and the costs of adverse effects associated with colonoscopy.

NICE Health Technology Evaluation Centre director Professor Carole Longson said distinguishing between IBS and more serious bowel disorders will allow patients to be better monitored and managed.

She said: ‘Faecal calprotectin testing helps doctors to distinguish between non-inflammatory disorders like IBS where sufferers will not come to serious harm and inflammatory bowel diseases such as Ulcerative Colitis or Crohn’s Disease – which need to be quickly referred to specialists.

‘Currently a number of tests are carried out in both hospitals and GPs’ surgeries to rule out conditions rather than to diagnose. This means people often face uncertainty, lots of visits to hospitals and their GP and repeated tests – some of them invasive and uncomfortable. Many people with IBD, particularly children with Crohn’s disease, sometimes have to wait for several years for confirmation of their condition.’

She added the tests could also reduce demands on colonoscopy departments: ‘The test is also likely to reduce the demands on colonoscopy departments which will be able to focus on people thought to have more serious conditions such as bowel cancer.’

Dr Jamie Dalrymple, chair of the Primary Care Society for Gastroenterology and a GP in Norwich said he welcomed the recommendation but advised caution when using the test on children: ‘It will be very useful to exclude IBD, especially Crohn’s disease. I would advise caution at the moment in children as the sensitivity and specificity are not as good as adults.’

Readers' comments (4)

  • Vinci Ho

    Any chance of giving us the actual sensitivity and specificity figures for adults and children , editor ?

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  • Dear Readers,

    I am the Product Manager for Calprotectin and am the person that put calprotectin forward to NICE.

    If you have any queries about calprotectin with in primary or secondary care, please contact me.... or more information, including published literature can be found on our dedicated website

    www.calprotectin.co.uk

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  • Contact details are
    awilliams@alphalabs.co.uk.

    A recent publication showing results of a QIPP/NTAC project can be found at

    http://www.ntac.nhs.uk/web/FILES/Publications/Faecal_Calprotectin_Report_Final.pdf

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  • Vinci Ho

    Meta-analysis by PF van Rheenen et al in 2010 , BMJ 2010;341;c3369 on Calprotectin suggested the test had
    Sensitivity 93%(95%CI 85-97%) ; Specificity 96%(95%CI 79-99%) in adults
    Sensitivity 92%(95%CI 84-96%) ; Specificity 76% (95% CI 62-86%) in children and teenagers
    13 studies included in analysis covering 670 adults and 371 children and teenager.
    Hence it is a good screening test in adults but sensitive not so specific in children ( hence more false positives picked up)

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