Fecal calprotectin – is it accepted by the patients?

Background:Fecal calprotectin (FC) is the most relevant inflammatory fecal biomarker in inflammatory bowel disease (IBD). This has been shown for diagnostic and monitoring issues and FC was included recently in various guidelines. To assess clinical practicability and patients acceptance to handle this stool test we retrospectively analyzed relevant parameters in a well defined IBD cohort.

Methods: Over a 4 year period patients were invited after proper information to bring a stool sample to each visit. Acceptance was calculated by the relation of FC to blood CRP which was routinely measured at each visit (FC/CRP ratio). Statistical significance was calculated by standard methods (Chi square testing) (Table 1).

Results: Data of 135 patients in 1529 visits were analysed. The mean age was 37,3 ± 12,7 years. 87 patients with Crohn's disease and 48 patients with ulcerative colitis were analyzed. The gender distribution was 68/69 males/females, 37 patients had a duration of disease > 5 years, 50% were on biologicals, 57% had an elevated CRP at least once per year.

Tab. 1: Acceptance ratio FC/CRP

Time period	2011 2012	2013 2014	p-Value
changes over time	0,13* 0,46	0,63 0,72*	* p < 0,001
male vs. female CD vs. UC Disease > 5 y vs. < 5 y	0,48 vs. 0,49 0,49 vs. 0,49 0,51 vs. 0,48		n.s. n.s. n.s.
Biologicals vs. none CRP ↑ vs. normal	0,49 vs. 0,49 0,44 vs. 0,56*		n.s. * p < 0.001

Summary and conclusion: The acceptance of the somewhat inconvenient stool sampling for FC testing grew over time significantly. FC testing is a highly accepted and convenient tool for estimating disease activity in IBD. An even higher acceptance rate might be achieved by point of care techniques for calprotectin detection.