2 e-Letters

  • Proton Pump Inhibitors may be the cause of an elevated faecal calprotectin.

    Practical Guidance on the use of faecal calprotectin

    Brookes MJ et al

    Frontline Gastroenterology 2018; 9:87-91

    Dear Sir

    I read this article with interest particularly as I work in a community gastroenterology unit.

    Our unit performs straight to test colonoscopy. We are referred a significant number of

    patients who present with loose motions but do not have alarm symptoms or worrying family

    histories.. Many of them are found to have faecal calprotectin levels which are only slightly

    elevated or in the intermediate range.

    Many of these patients are also taking proton pump inhibitors on a regular basis. A

    colonoscopy is performed and colonic biopsies are taken which are almost always

    normal. A paper, albeit with small numbers of patients, showed that proton pump
    inhibitors may cause a rise in faecal calprotectin levels in normal subjects.

    I recommend that, when it is safe and appropriate to do so, the GP considers stopping

    proton pump inhibitors in such patients and repeats the faecal calprotectin in four weeks.

    The aim here is to avoid unnecessary colonoscopy in a low-risk young patients, most of

    whom have functionally related symptoms. I recent...

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  • Probably even less effective than claimed

    The authors rightly point out the low yield of gastroscopy in the management of, even complicated, dyspepsia. In fact it looks like gastroscopy is even less useful than the authors claim. There are several important points in the paper that deserve wider discussion. Firstly the authors state that they studied patients over 55 undergoing gastroscopy for dyspepsia, yet the mean age in the cohort was 58 with a standard deviation of 16 years: this implies that actually a substantial proportion of the subjects were in fact well under 55. The data on which the current 2-week wait pathways were based showed that the positive predictive value of all dyspeptic type symptoms, or symptom-combinations, in those under 55 was less than 1%, [1]. Hence by including these patients, the authors have not only confused the reading of their paper but also altered the potential perception of the utility of gastroscopy in relation to the 2-week wait criteria.
    Additionally the claimed usefulness of gastroscopy in 16% of cases seems rather high. Of the cancers in the cohort 3 out of 4 would have has a gastroscopy for indications over and above simple dyspepsia, at least 5 of the "positive" cases seemed to have been having the gastroscopy to obtain histology for a previously suspected condition (hence not simple dyspepsia), 12 benign ulcers would have been managed with acid suppression whether or not a gastroscopy was performed, presumably the oesophageal strictures significant enou...

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