How often, and in which circumstances, do you use Calprotectin, ANCA and ASCA, for diagnosis of Crohn's disease and ulcerative colitis? Do you use calprotectin for follow up of the disease?
At our Center for Crohn's and Colitis at BWH, we rarely use serology markers such as ANCA and ASCA to diagnose the type of IBD. We may only send these studies off if the case is truly indeterminate and you really need to know Crohns vs UC (like before a contemplated surgery). Fecal calprotectin is a very sensitive marker for active IBD that we are using a lot now to help diagnose IBD (vs IBS or other functional bowel disorder), or to follow the degree of inflammation during treatment of IBD. A draw back to this test is the fact that it is a stool study and the cost.
I agree completely with Dr. Hamilton. I would add that calprotectin is very sensitive, but not specific, and this should be kept in mind at all times.
In my experience, the fecal research of pathologic values of Calprotectin is very useful if integrated with clinical symptoms of the patient. When Fecal Calprotectin is elevated, I consider always invasive examination as Colonscopy to research Inflammatory Bowel Disease. I think that fecal Calprotectin is a very useful marker for early diagnosis of Inflammatory Bowel Disease
As we demonstrated in a conference paper presented last year in the SIGENP congress in Italy "Functional and organic abdominal pain: role of fecal calprotectin and common serum markers in the differential diagnosis.-" by D.Vernuccio, P.Melli, G.Spagnut, S.Celestino, P.Collarile, E.Tonutti, F.Vernuccio, A.Rosolen. Abstracts / Digestive and Liver Disease 45 (2013) e263–e311, FC and serum inflammatory markers can help in the differential diagnosis of recurrent abdominal pain in CHILDREN and in identifying patients who are most likely to benefit from endoscopy for suspected IBD
I agree with Dr Hamilton. In my practice, fecal calprotectin dosage is very useful for early diagnosis of Inflammatory Bowel Disease but this dosage is very important in the follow-up with IBD patients, particularly after surgery and loss of response to 5-ASA and Azathioprine
ANCA and ASCA have a low sensitivity and therefore are of little help for the diagnosis, whilst fecal calprotectin may be a useful tool for the early diagnosis and follow up of inflammatory bowel diseases.
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