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Letters to the editor
What calprotectin cut-offs should apply for IBD in general practice?
  1. Darryl Landis1,
  2. Pali Hungin2,
  3. Daniel Hommes3
  1. 1Department of Medical Affairs, Genova Diagnostics, Asheville, North Carolina, USA
  2. 2School of Medicine and Health, Durham University, Centre for Integrated Health Research Wolfson Research Institute, Stockton on Tees, UK
  3. 3Center for Inflammatory Bowel Diseases, University of California at Los Angeles Health System, Los Angeles, California, USA
  1. Correspondence to Dr Darryl Landis, Department of Medical Affairs, Genova Diagnostics, Asheville, NC, 28801, USA; dlandis{at}gdx.net

https://doi.org/10.1136/flgastro-2015-100605

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    To the Editor

    We write in response to the recent article by Dhaliwal et al1 in Frontline Gastroenterology, which discussed the utility of faecal calprotectin (FC) levels in discriminating between inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS). We applaud the authors’ investigation of this important topic given the high prevalence of IBS in general practice, the understandable concern of practitioners in reliably excluding inflammatory conditions in patients with IBS and the imperative to avoid unnecessary diagnostic evaluations.

    The main reported results of the Dhaliwal study support previous findings in the published literature that, at a cut-off of 50 µg/g, FC determination demonstrates adequate sensitivity and specificity to distinguish between IBS and IBD.2 The authors note, however, that raising the cut-off to 100 µg/g ‘does further improve’ sensitivity and specificity of the FC test, and improves the negative predictive value (NPV) to 97% from 87%. This statement highlights several practical concerns that we believe are of substantial importance for both general practitioners and medical policy decision-makers when interpreting the extensive literature on the role of FC in differentiating IBS and IBD.

    First, it is essential for readers …

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