Fecal calprotectin, intestinal ultrasound, and their combination for the diagnosis of inflammatory bowel disease

IF 2.6 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Clinics and research in hepatology and gastroenterology Pub Date : 2025-02-03 DOI:10.1016/j.clinre.2025.102549

Serge Dubian , Clara Yzet , Franck Brazier , Thierry Yzet , Vincent Hautefeuille , Catherine Decrombecque , Quentin Bocquillon , Nicolas Richard , Anthony Buisson , Jonathan Meynier , Mathurin Fumery

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Abstract

Background

We aimed to evaluate the diagnostic accuracy of fecal calprotectin (FC) and intestinal ultrasound (IUS), independently and in combination, as screening tools for adults with suspected IBD to reduce the number of unnecessary endoscopic procedures.

Methods

We conducted a retrospective monocentric study that included consecutive adult patients with (i) ileocolonoscopy for suspected IBD between January 2021 and June 2023 who had either (ii) IUS and/or (iii) a FC test within 6 weeks. Bowel wall thickness (BWT) and the color Doppler signal (CDS) were evaluated for all segments. The presence of lymphadenopathy, loss of stratification, stricture, and fistula were also recorded.

Results

In total, 119 patients with a median age of 32 years (IQR, 24.0–41.0) were included. The most common symptoms were abdominal pain (n = 88, 75 %) and chronic diarrhea (n = 89, 75 %). Among the 119 patients, 74 (62 %) had IUS, 101 (82 %) had a FC test, and 56 (47 %) had both. Forty patients (34 %) had a diagnosis of IBD, including 31 (26 %) with CD and 9 (8 %) with UC. By ROC curve analysis, the best threshold of FC to diagnose IBD was 117 ug/g (Se 97 %, Sp 73 %, PPV 67 %, NPV 98 %, AUC 0.88, 95 %CI [0.81; 0.94], p = 0.006). Using this threshold, only 3 % of patients were misclassified as non-IBD. Screening by measuring FC levels would result in a 48 % reduction in the number of adults requiring endoscopy. Abnomal IUS was significantly associated with a diagnosis of IBD (OR 5.6, 95 %IC [2.1;16.2], P = 0.0008). The association of a BWT>3 mm and a positive CDS was associated with a Se, Sp, PPV, and NPV of 48 %, 100 %, 100 %, and 75 %, respectively, but 52 % of patients were misclassified as non-IBD. The combination of a BWT>3 mm, CDS, and FC>117 ug/g had a Se, Sp, PPV, and NPV of 44 %, 100 %, 100 %, and 69 %, respectively. For patients with a normal IUS and FC<117 ug/g, 4 % were misclassified as non-IBD.

Conclusions

The combination of FC and IUS is a useful screening strategy to identify patients who truly require endoscopy for suspected IBD. Calprotectin is a highly effective test for ruling out IBD. Conversely, relying solely on IUS lacks the discriminative power to safely rule out IBD. However, it shows a high PPV and is a potent tool for diagnosing IBD.

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来源期刊

Clinics and research in hepatology and gastroenterology GASTROENTEROLOGY & HEPATOLOGY-

CiteScore

4.30

自引率

3.70%

发文量

198

审稿时长

42 days

期刊介绍： Clinics and Research in Hepatology and Gastroenterology publishes high-quality original research papers in the field of hepatology and gastroenterology. The editors put the accent on rapid communication of new research and clinical developments and so called "hot topic" issues. Following a clear Editorial line, besides original articles and case reports, each issue features editorials, commentaries and reviews. The journal encourages research and discussion between all those involved in the specialty on an international level. All articles are peer reviewed by international experts, the articles in press are online and indexed in the international databases (Current Contents, Pubmed, Scopus, Science Direct). Clinics and Research in Hepatology and Gastroenterology is a subscription journal (with optional open access), which allows you to publish your research without any cost to you (unless you proactively chose the open access option). Your article will be available to all researchers around the globe whose institution has a subscription to the journal.