P212 Should inpatient faecal calprotectin requests be rejected?

Introduction

Faecal calprotectin is extremely sensitive to gut inflammation, and as such, is less sensitive to the diagnosis of inflammatory bowel disease (IBD) in patients presenting with acute symptoms. Local guidelines suggest faecal calprotectin test to be performed in patients between the ages of 18 and 50, with lower gastrointestinal symptoms with loose stools for longer than four weeks.

Methods

All inpatient faecal calprotectin requests in 2019 at the Royal Glamorgan Hospital (RGH) were obtained. Data collection included patient identifiable number, request indication, faecal calprotectin level, current IBD status, presenting symptom, if endoscopy was conducted and if a new diagnosis of IBD was made.

Results

There were 63 inpatients who had faecal calprotectin tests performed, of which 44 were adult patients (>18-year-old). Only adult patients were included in this study. The patients were categorized into faecal calprotectin level groups. Four patients(9%) were known to have IBD, all of whom have levels >600. The most common request indication was diarrhoea (18 patients; 40%), of which twelve had ‘ongoing diarrhoea’. Nineteen patients (50%) had some form of endoscopy performed. Table 1 shows the percentage of patients who had endoscopy in the respective faecal calprotectin level groups. A new diagnosis of IBD was made on three patients, all of whom had faecal calprotectin levels >600. Indications for the initial faecal calprotectin tests include ‘ongoing diarrhoea’, rectal bleeding and ‘colitis on imaging’.

Conclusions

1) The majority of adult inpatient faecal calprotectin requests were inappropriate for age and indication criteria. Based on local guidelines, only two of the twelve patients who had ‘ongoing diarrhoea’ were older than 50-years-old. Both underwent colonoscopy, where one had no evidence of IBD while the other patient is pending follow-up. There is no association between faecal calprotectin levels and if patients had endoscopy performed. Faecal calprotectin levels >600 gave a 50% pick up rate (3/6 had IBD) but 2/3 would have met the criteria for further colonoscopy regardless of faecal calprotectin level. Inpatient faecal calprotectin test is not a cost–effective way of screening for IBD. Stopping this practice might save the NHS approximately £2000/year at RGH alone and potentially avoid unnecessary endoscopy tests. Discussion between consultant Gastroenterologists and consultant clinical lead in Biochemistry led to a decision to reject all inpatient faecal calprotectin requests not requested by Gastroenterology, Colorectal Surgery or Paediatrics at RGH.