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 17 October 2017

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Predictors of small bowel Crohn's in patients undergoing capsule endoscopy

The latest issue of the Scandanavian Journal of Gastroenterology reports on a prospective study of fecal calprotectin and lactoferrin as predictors of small bowel Crohn's disease in patients undergoing capsule endoscopy.

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Capsule endoscopy is often used to investigate small bowel Crohn's disease (CD).

Dr Ariella Bar-Gil Shitrit and colleagues from Israel prospectively assessed the value of fecal calprotectin and lactoferrin to predict capsule endoscopy findings.

The team included 68 consecutive patients that were referred for capsule endoscopy. 

Stool samples for calprotectin and lactoferrin and blood samples were collected for relevant parameters. 

Correlation between fecal markers and capsule endoscopy findings was assessed, and receiver operating characteristic curves were built to determine the predictive values of fecal markers for the diagnosis of CD.

The team reported that fecal calprotectin data was available for all the patients and lactoferrin data for 38. 

A fecal calprotectin concentration of 95 mg/kg had a sensitivity of 77%
Scandanavian Journal of Gastroenterology
The team found capsule endoscopy findings compatible with CD in 33% of patients, and 67% were negative for CD. 

The average age of the CD group was 34 compared to 46 in the non-CD group.

The researchers observed that median calprotectin and lactoferrin in the CD group, and in the control group were 169 mg/kg vs. 40, and 6.6 mg/kg vs. 1, respectively. 

The team observed that the area under the ROC curve was 0.8 for calprotectin, and 0.7 for lactoferrin. 

A fecal calprotectin concentration of 95 mg/kg, and fecal lactoferrin of 1.05 mg/kg had a sensitivity, specificity, positive predictive value and negative predictive value of 77% and 73%, 60% and 65%, 50% and 50%, and 84% and 84% in predicting capsule endoscopy findings compatible with CD.

Dr Bar-Gil Shitrit's team concludes, "Fecal markers are simple and noninvasive surrogates for predicting capsule endoscopy findings compatible with CD."

"Fecal markers can help determine which patients should be referred for capsule endoscopy."

Scand J Gastroenterol 2017: 52(3)
20 January 2017

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