Alimentary Tract
Diagnostic value of faecal calprotectin in paediatric gastroenterology clinical practice

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Abstract

Background. Faecal calprotectin (FC) is a new marker of intestinal inflammation. Data on FC in paediatric gastroenterology clinical practice are still scarce.

Aims. To assess FC values in different paediatric gastrointestinal diseases comparing them with those obtained in healthy children.

Patients. Two hundred and eighty-one children (age range 13–216 months) consecutively referred for gastrointestinal symptoms. Seventy-six healthy controls (age range 13–209 months). The exclusion criteria in healthy children were the following: any known underlying chronic disease or a history of abdominal pain, diarrhoea, acute respiratory tract infection, intake of non-steroidal anti-inflammatory drugs, gastric acidity inhibitors, antibiotics, drugs influencing gut motility, and menstrual or nasal bleeding in the last 3 weeks.

Methods. Stool samples stored, prepared and analyzed by an ELISA assay.

Results. In healthy children the median FC value was 28.0 μg/g (15–57 interquartile range) with a 95th percentile value of 95.3 μg/g. An increase in FC concentration was observed in all diseases characterized by gastrointestinal mucosa inflammation, and the active inflammatory bowel disease patients showed the higher FC values. All children affected by functional bowel disorders or by non-inflammatory diseases showed normal values. We calculated an optimized FC cut off value of 102.9266 μg/g (revealed by the receiver operating characteristic curve) to distinguish patients with active organic/inflammatory disorders from healthy subjects and from patients with functional bowel disorders.

Conclusions. Calprotectin is a sensitive, but not disease specific, marker to easily detect inflammation throughout the whole gastrointestinal tract. It may help in identifying an organic disease characterized by intestinal mucosa inflammation and in the differential diagnosis of functional bowel disorders.

Introduction

Testing children with gastrointestinal symptoms while limiting the number of expensive and invasive procedures is a continuous challenge in paediatric clinical practice, e.g. to distinguish between functional disorders and a prodromal period of inflammatory bowel disease (IBD). A number of leukocyte-derived proteins have been proposed as non-invasive inflammation bio-markers, including eosinophilic cationic protein (ECP), elastase, esterase, myeloperoxidase, lysozyme, lactoferrin, and calprotectin [1], [2], [3]. Compared to these other candidates, calprotectin may offer performance advantages based on its biological characteristics. Specifically, this 36.5-kDa non-glycosylated polypeptide accounts for up to 60% of the cytosolic proteins found in neutrophils and macrophages [4], [5]. Additionally, calprotectin is stable in the stools for more than seven days which may be at least in part due to the high Ca2+ concentration in gut lumen, which makes it resistant to proteolytic degradation [2], [6]. Experiences with IBD children are encouraging and suggest that faecal calprotectin (FC) provides reliable information in the routine diagnostic work-up [7], [8]. However, data on FC in other common gastrointestinal paediatric diseases are still scarce. The purpose of this study was to assess FC values in common gastrointestinal diseases in paediatric clinical practice comparing them with those obtained in healthy subjects. In addition, reference FC values for healthy children were also presented for convenient use in clinical practice.

Section snippets

Patients and methods

Children (age range 13–216 months) consecutively referred to our department for gastrointestinal symptoms were invited to participate in the study. Two hundred and eighty-one children with gastrointestinal diseases were enrolled. As controls, a faecal sample was obtained from 76 healthy children. These subjects were recruited from children visiting our department for routine examination and also from families of our staff. The exclusion criteria were the following: any known underlying chronic

Results

The FC values in healthy children and in patients with various gastrointestinal disorders are reported in Fig. 1 and in Table 2. In healthy children the median FC value was 28.0 μg/g (15–57 interquartile range). There were no differences in FC values attributable to age or sex. The 5th, 50th and 95th percentile FC values in healthy controls were 3.0, 28.0 and 95.3 μg/g, respectively. Children with active IBD, defined by clinical, endoscopic and histological parameters, showed significantly higher

Discussion

Despite the large amount of literature on calprotectin in recent years, data on children are incomplete, and the exact reference range for healthy children is still not completely defined. We reported it in this study indicating the 5th to 95th percentile FC value control range (3.0 and 95.3 μg/g, respectively). These data could be useful in clinical practice as reference values for children with ages ranging from 2 to 18 years. It has been previously shown that infants have higher FC values

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