IBD Stool tests: Are they useful? - Dr. Falk Pharma · IBD Stool tests: Are they useful? Ingvar...
Transcript of IBD Stool tests: Are they useful? - Dr. Falk Pharma · IBD Stool tests: Are they useful? Ingvar...
![Page 1: IBD Stool tests: Are they useful? - Dr. Falk Pharma · IBD Stool tests: Are they useful? Ingvar Bjarnason ... The history of stool tests ... R E M I S S I O N Month p < 0.0001. Calprotectin](https://reader030.fdocuments.net/reader030/viewer/2022011819/5e9c088586015b2abd23494c/html5/thumbnails/1.jpg)
IBDStool tests: Are they useful?
Ingvar BjarnasonProfessor of Digestive DiseasesKing’s College HospitalLondonUK
![Page 2: IBD Stool tests: Are they useful? - Dr. Falk Pharma · IBD Stool tests: Are they useful? Ingvar Bjarnason ... The history of stool tests ... R E M I S S I O N Month p < 0.0001. Calprotectin](https://reader030.fdocuments.net/reader030/viewer/2022011819/5e9c088586015b2abd23494c/html5/thumbnails/2.jpg)
1965-2000• Endoscopy• Enteroscopy (capsule, push, balloon)• Colonoscopy
Good for diagnosisProvide no functional information
![Page 3: IBD Stool tests: Are they useful? - Dr. Falk Pharma · IBD Stool tests: Are they useful? Ingvar Bjarnason ... The history of stool tests ... R E M I S S I O N Month p < 0.0001. Calprotectin](https://reader030.fdocuments.net/reader030/viewer/2022011819/5e9c088586015b2abd23494c/html5/thumbnails/3.jpg)
EndoscopySuperb for diagnosis
Transformed Gastroenterology
Provides no functional information
![Page 4: IBD Stool tests: Are they useful? - Dr. Falk Pharma · IBD Stool tests: Are they useful? Ingvar Bjarnason ... The history of stool tests ... R E M I S S I O N Month p < 0.0001. Calprotectin](https://reader030.fdocuments.net/reader030/viewer/2022011819/5e9c088586015b2abd23494c/html5/thumbnails/4.jpg)
Why stool tests?Neurologists CSFUrologists UrineRheumatologists Synovial fluidRespiratory phys, SputumGastroeterologists ?
Stool analyses provide direct informationon the gastrointestinal tract
![Page 5: IBD Stool tests: Are they useful? - Dr. Falk Pharma · IBD Stool tests: Are they useful? Ingvar Bjarnason ... The history of stool tests ... R E M I S S I O N Month p < 0.0001. Calprotectin](https://reader030.fdocuments.net/reader030/viewer/2022011819/5e9c088586015b2abd23494c/html5/thumbnails/5.jpg)
Faecal stool tests: Potential uses
• To distinguish between IBD and IBS• To assess laboratory disease activity in IBD• To assess responses to treatment• To assess prognosis of disease• Research uses
![Page 6: IBD Stool tests: Are they useful? - Dr. Falk Pharma · IBD Stool tests: Are they useful? Ingvar Bjarnason ... The history of stool tests ... R E M I S S I O N Month p < 0.0001. Calprotectin](https://reader030.fdocuments.net/reader030/viewer/2022011819/5e9c088586015b2abd23494c/html5/thumbnails/6.jpg)
The history of stool tests• Coproscopy:
• Visual stool examination practiced since antiquity• Microscopy for parasites, white cells, etc
• Faecal fats, radioisotopic tests (RBC, proteins, etc.)
• Radioimmunoassay + ELISA • Tumor necrosis factor• Myeloperoxidase• Lactoferrin• Calprotectin
![Page 7: IBD Stool tests: Are they useful? - Dr. Falk Pharma · IBD Stool tests: Are they useful? Ingvar Bjarnason ... The history of stool tests ... R E M I S S I O N Month p < 0.0001. Calprotectin](https://reader030.fdocuments.net/reader030/viewer/2022011819/5e9c088586015b2abd23494c/html5/thumbnails/7.jpg)
• 111Indium White Cells• Abdominal scintigraphy• 4 day faecal 111Indium excretion• Results
• 100% sensitive for detection of IBD• Faecal excretion correlates with histological
and clinical disease activity indices in Crohn’s and UC
Intestinal inflammation
![Page 8: IBD Stool tests: Are they useful? - Dr. Falk Pharma · IBD Stool tests: Are they useful? Ingvar Bjarnason ... The history of stool tests ... R E M I S S I O N Month p < 0.0001. Calprotectin](https://reader030.fdocuments.net/reader030/viewer/2022011819/5e9c088586015b2abd23494c/html5/thumbnails/8.jpg)
Validation:Faecal calprotectinFaecal lactoferrin
Validation against 111In White cellsEqual sensitivity
D‘Inca et al Int J Colorectal Dis 2007;22:429-437Angriman et al Clin Chim Acta 2007 in press
Langhorst et al. Inflamm Bowel Dis 2005;11:1085-1091
![Page 9: IBD Stool tests: Are they useful? - Dr. Falk Pharma · IBD Stool tests: Are they useful? Ingvar Bjarnason ... The history of stool tests ... R E M I S S I O N Month p < 0.0001. Calprotectin](https://reader030.fdocuments.net/reader030/viewer/2022011819/5e9c088586015b2abd23494c/html5/thumbnails/9.jpg)
Calprotectin v. 111IndWBC
0
100
200
300
400
500
600
700
800
Faec
al c
alpr
otec
tin e
xcre
tion
ove
r 4 d
ays (
mg)
0 10 20 30 40 50 60
4 day faecal 111Indium excretion
0
100
200
300
400
500
600
700
800
Cal
prot
ectin
con
cent
ratio
n
in
sing
le st
ool (
mg/
L)0 10 20 30 40 50 60
4 day faecal 111Indium excretion
3800 1487
![Page 10: IBD Stool tests: Are they useful? - Dr. Falk Pharma · IBD Stool tests: Are they useful? Ingvar Bjarnason ... The history of stool tests ... R E M I S S I O N Month p < 0.0001. Calprotectin](https://reader030.fdocuments.net/reader030/viewer/2022011819/5e9c088586015b2abd23494c/html5/thumbnails/10.jpg)
Faecal Calprotectin con.
• 116 patients with Crohn’s disease• Various disease activity
0.1
1
10
100
1000
> 1.000
Faec
al c
once
ntra
tion
of c
alpr
otec
tin (m
g/L)
Controls Crohn's disease
![Page 11: IBD Stool tests: Are they useful? - Dr. Falk Pharma · IBD Stool tests: Are they useful? Ingvar Bjarnason ... The history of stool tests ... R E M I S S I O N Month p < 0.0001. Calprotectin](https://reader030.fdocuments.net/reader030/viewer/2022011819/5e9c088586015b2abd23494c/html5/thumbnails/11.jpg)
Faecal Calprotectin
602 (-275)= consecutive patients referred with lower GI symptoms to GI outpatients that required imaging
Can we discriminate between Patients with and withoutIntestinal inflammation?
Tibble et al. Gastroenterology 2002;123:450-460
![Page 12: IBD Stool tests: Are they useful? - Dr. Falk Pharma · IBD Stool tests: Are they useful? Ingvar Bjarnason ... The history of stool tests ... R E M I S S I O N Month p < 0.0001. Calprotectin](https://reader030.fdocuments.net/reader030/viewer/2022011819/5e9c088586015b2abd23494c/html5/thumbnails/12.jpg)
0.1
1
10
100
1000
10000
Faec
al C
alpt
otec
tin (m
g/L)
IBD Cancer Enteropathy Coeliac IBS Crohn's UC Infective Diverticular Diabetic Disease diarrhoea disease diarrhoea
![Page 13: IBD Stool tests: Are they useful? - Dr. Falk Pharma · IBD Stool tests: Are they useful? Ingvar Bjarnason ... The history of stool tests ... R E M I S S I O N Month p < 0.0001. Calprotectin](https://reader030.fdocuments.net/reader030/viewer/2022011819/5e9c088586015b2abd23494c/html5/thumbnails/13.jpg)
Odds ratio of + test to show organic disease
CalprotectinIntestinal permeabilityCRPESR
ROME = IBS
27.88.94.23.2
13.3
Normal Calp. + ROME > 50
![Page 14: IBD Stool tests: Are they useful? - Dr. Falk Pharma · IBD Stool tests: Are they useful? Ingvar Bjarnason ... The history of stool tests ... R E M I S S I O N Month p < 0.0001. Calprotectin](https://reader030.fdocuments.net/reader030/viewer/2022011819/5e9c088586015b2abd23494c/html5/thumbnails/14.jpg)
Normal calpro and + ROME• Virtually excludes organic intestinal disease• Does not warrant any diagnostic imaging
![Page 15: IBD Stool tests: Are they useful? - Dr. Falk Pharma · IBD Stool tests: Are they useful? Ingvar Bjarnason ... The history of stool tests ... R E M I S S I O N Month p < 0.0001. Calprotectin](https://reader030.fdocuments.net/reader030/viewer/2022011819/5e9c088586015b2abd23494c/html5/thumbnails/15.jpg)
1
10
100
1000
Fae
cal C
alpr
otec
tin (m
g/L)
CDAI < 150 CDAI > 150
![Page 16: IBD Stool tests: Are they useful? - Dr. Falk Pharma · IBD Stool tests: Are they useful? Ingvar Bjarnason ... The history of stool tests ... R E M I S S I O N Month p < 0.0001. Calprotectin](https://reader030.fdocuments.net/reader030/viewer/2022011819/5e9c088586015b2abd23494c/html5/thumbnails/16.jpg)
Calprotectin predicts relapse in asymptomatic IBD
• 81 asymptomatic patients underwent the calprotectin test
• Follow up for 1 year• 55% relapsed
• Faecal calprotectin• Relapse: 122 mg/L• Non-rela: 36 mg/L
• At 50 mg/L the test has 90% sensitivity and 83% specificity for predicting relapse
Tibble et al Gastroenterology 2000;119:15-22Costa et al GUT 2005;54:364-368
![Page 17: IBD Stool tests: Are they useful? - Dr. Falk Pharma · IBD Stool tests: Are they useful? Ingvar Bjarnason ... The history of stool tests ... R E M I S S I O N Month p < 0.0001. Calprotectin](https://reader030.fdocuments.net/reader030/viewer/2022011819/5e9c088586015b2abd23494c/html5/thumbnails/17.jpg)
Gastroenterology 2000;119:15-22
Calprotectin as a predictor of relapse in IBD
2 4 6 8 10 12
1.0
0.8
0.4
0.2
0
U.C < 250 mg/L
C.D > 250 mg/LU.C >250 mg/L
C.D < 250 mg/L
REMISSION
Month
p < 0.0001
![Page 18: IBD Stool tests: Are they useful? - Dr. Falk Pharma · IBD Stool tests: Are they useful? Ingvar Bjarnason ... The history of stool tests ... R E M I S S I O N Month p < 0.0001. Calprotectin](https://reader030.fdocuments.net/reader030/viewer/2022011819/5e9c088586015b2abd23494c/html5/thumbnails/18.jpg)
Calprotectin predicts relapse in asymptomatic patients with IBD
Can we treat these at risk patients andPrevent the clinical relapse?
![Page 19: IBD Stool tests: Are they useful? - Dr. Falk Pharma · IBD Stool tests: Are they useful? Ingvar Bjarnason ... The history of stool tests ... R E M I S S I O N Month p < 0.0001. Calprotectin](https://reader030.fdocuments.net/reader030/viewer/2022011819/5e9c088586015b2abd23494c/html5/thumbnails/19.jpg)
Open, prospective, randomised controlled trialNumber of patients: 66Asymptomatic with calprotectin > 250
Study Design
Screening Week 1
Week 2
Week 3
Week 4
Week 5
Evaluation visits Month 2-6
Group 1
Group 2 Unchanged treatment
![Page 20: IBD Stool tests: Are they useful? - Dr. Falk Pharma · IBD Stool tests: Are they useful? Ingvar Bjarnason ... The history of stool tests ... R E M I S S I O N Month p < 0.0001. Calprotectin](https://reader030.fdocuments.net/reader030/viewer/2022011819/5e9c088586015b2abd23494c/html5/thumbnails/20.jpg)
Remission in Month 6
21 (68%)8 (27%)Relapse
10 (32%)21 (72%)Remission
ControlAdacolumn
![Page 21: IBD Stool tests: Are they useful? - Dr. Falk Pharma · IBD Stool tests: Are they useful? Ingvar Bjarnason ... The history of stool tests ... R E M I S S I O N Month p < 0.0001. Calprotectin](https://reader030.fdocuments.net/reader030/viewer/2022011819/5e9c088586015b2abd23494c/html5/thumbnails/21.jpg)
Survival analysis
0 50 100 150 200 250Time
0.0
0.2
0.4
0.6
0.8
1.0Su
rviv
or F
unct
ion
UnchangedAda
GROUP
p<0.05
Method: Mantel-Haenszel
![Page 22: IBD Stool tests: Are they useful? - Dr. Falk Pharma · IBD Stool tests: Are they useful? Ingvar Bjarnason ... The history of stool tests ... R E M I S S I O N Month p < 0.0001. Calprotectin](https://reader030.fdocuments.net/reader030/viewer/2022011819/5e9c088586015b2abd23494c/html5/thumbnails/22.jpg)
New indication for treatment in IBD
• Calprotectin identifies a group of patients at significant risk of clinical relapse
• Treatment reduces relapse rates• Asymptomatic patients with calprotectin < 250
may not need continuous 5-ASA etc.
![Page 23: IBD Stool tests: Are they useful? - Dr. Falk Pharma · IBD Stool tests: Are they useful? Ingvar Bjarnason ... The history of stool tests ... R E M I S S I O N Month p < 0.0001. Calprotectin](https://reader030.fdocuments.net/reader030/viewer/2022011819/5e9c088586015b2abd23494c/html5/thumbnails/23.jpg)
Treatment of established active IBD
![Page 24: IBD Stool tests: Are they useful? - Dr. Falk Pharma · IBD Stool tests: Are they useful? Ingvar Bjarnason ... The history of stool tests ... R E M I S S I O N Month p < 0.0001. Calprotectin](https://reader030.fdocuments.net/reader030/viewer/2022011819/5e9c088586015b2abd23494c/html5/thumbnails/24.jpg)
Faecalcalprotectinmg/l
100
1000
2000
3000Remicade
Weeks
Remicade
Remicade
Calprotectin in a patient with CD receiving Remicade (Infliximab)
![Page 25: IBD Stool tests: Are they useful? - Dr. Falk Pharma · IBD Stool tests: Are they useful? Ingvar Bjarnason ... The history of stool tests ... R E M I S S I O N Month p < 0.0001. Calprotectin](https://reader030.fdocuments.net/reader030/viewer/2022011819/5e9c088586015b2abd23494c/html5/thumbnails/25.jpg)
Calprotectin and CRP levels in patients w/CD before and after Remicade
RelapsedCR
P mg/
L
Weeks
Faec
al C
alpr
otec
tin
mg/
l
Weeks
1000
2000
3000
4000
10
20
40
30
Pneumonia
Relapsed
![Page 26: IBD Stool tests: Are they useful? - Dr. Falk Pharma · IBD Stool tests: Are they useful? Ingvar Bjarnason ... The history of stool tests ... R E M I S S I O N Month p < 0.0001. Calprotectin](https://reader030.fdocuments.net/reader030/viewer/2022011819/5e9c088586015b2abd23494c/html5/thumbnails/26.jpg)
10
100
1000
10 000
20 000
1
Calprotectin mg/LLog scale
�
Crohn´s diseaseactive / remission
Ulcerative colitisactive / remission
* * p< 0.0001*
Calprotectin levels in IBD patients with active disease and during mucosal healing
Scand J Gastro 2004
Mucosal healing
![Page 27: IBD Stool tests: Are they useful? - Dr. Falk Pharma · IBD Stool tests: Are they useful? Ingvar Bjarnason ... The history of stool tests ... R E M I S S I O N Month p < 0.0001. Calprotectin](https://reader030.fdocuments.net/reader030/viewer/2022011819/5e9c088586015b2abd23494c/html5/thumbnails/27.jpg)
0
50
100
150
200
250
300C
alpr
otec
tin (g
/L)
Active IBD Prednisolone Elemental Azathioprine diet
Faecal calprotectin
![Page 28: IBD Stool tests: Are they useful? - Dr. Falk Pharma · IBD Stool tests: Are they useful? Ingvar Bjarnason ... The history of stool tests ... R E M I S S I O N Month p < 0.0001. Calprotectin](https://reader030.fdocuments.net/reader030/viewer/2022011819/5e9c088586015b2abd23494c/html5/thumbnails/28.jpg)
Research uses:Effect of NSAIDs on IBD
Case reports• Cause relapse of Crohn’s and UC• Occurs within a week of treatment• Seen with indomethacin,
naproxen, diclofenac, etc.
![Page 29: IBD Stool tests: Are they useful? - Dr. Falk Pharma · IBD Stool tests: Are they useful? Ingvar Bjarnason ... The history of stool tests ... R E M I S S I O N Month p < 0.0001. Calprotectin](https://reader030.fdocuments.net/reader030/viewer/2022011819/5e9c088586015b2abd23494c/html5/thumbnails/29.jpg)
Prevalence of relapse of IBD with NSAIDs
Patients with quiescent IBD
Within 9 days of taking the drugs
0
28
1723
0
10
20
30
40
50
Paracetamol
(n = 26)
Naproxen
(n = 32)
Diclofenac
(n = 29)
Indomethacin
(n = 22)
Relapse (%)
Takeutchi et al Clin Gastroenterol Hepatol. 2006;4:196-202
![Page 30: IBD Stool tests: Are they useful? - Dr. Falk Pharma · IBD Stool tests: Are they useful? Ingvar Bjarnason ... The history of stool tests ... R E M I S S I O N Month p < 0.0001. Calprotectin](https://reader030.fdocuments.net/reader030/viewer/2022011819/5e9c088586015b2abd23494c/html5/thumbnails/30.jpg)
Mechanism of relapse80 patients with IBD taking NSAIDs
COX-1 COX-2 Topical
• Paracetamol 0 0 0
• Naproxen + + +
• Nabumetone + + 0
• Nimesulide 0 + 0
Relapse defined clinically (CDAI)Inflammation by calprotectin
![Page 31: IBD Stool tests: Are they useful? - Dr. Falk Pharma · IBD Stool tests: Are they useful? Ingvar Bjarnason ... The history of stool tests ... R E M I S S I O N Month p < 0.0001. Calprotectin](https://reader030.fdocuments.net/reader030/viewer/2022011819/5e9c088586015b2abd23494c/html5/thumbnails/31.jpg)
0
500
1000
1500
1500
0
500
1000
1500
0
500
1000
1500
Paracetamol2500*
Feca
l Cal
prot
ectin
+
Naproxen
5600
4700*
+
+Feca
l Cal
prot
ectin
week 0 1 4
*
*
*
0
500
1000
1500
week 0 1 4
Nabumetone 1200028002500
***
*
Feca
l Cal
prot
ectin
week 0 1 4
72005400
*Fe
cal C
alpr
otec
tin
+
week 0 1 4
Nimesulide
Aspirin
![Page 32: IBD Stool tests: Are they useful? - Dr. Falk Pharma · IBD Stool tests: Are they useful? Ingvar Bjarnason ... The history of stool tests ... R E M I S S I O N Month p < 0.0001. Calprotectin](https://reader030.fdocuments.net/reader030/viewer/2022011819/5e9c088586015b2abd23494c/html5/thumbnails/32.jpg)
Research uses:Subclinical intestinal inflammation in IBD
relatives
![Page 33: IBD Stool tests: Are they useful? - Dr. Falk Pharma · IBD Stool tests: Are they useful? Ingvar Bjarnason ... The history of stool tests ... R E M I S S I O N Month p < 0.0001. Calprotectin](https://reader030.fdocuments.net/reader030/viewer/2022011819/5e9c088586015b2abd23494c/html5/thumbnails/33.jpg)
Intestinal inflammation in Crohn’s disease relatives• 49 patients and 151 of their 220 (58%) first
degree relatives were studied for the presence of intestinal inflammation by the faecal caplrotectin test
49% of relatives had intestinal inflammation
Inheritance pattern = additive traitVariant component analyses
Gastroenterology. 2003;124:1728-1737.
![Page 34: IBD Stool tests: Are they useful? - Dr. Falk Pharma · IBD Stool tests: Are they useful? Ingvar Bjarnason ... The history of stool tests ... R E M I S S I O N Month p < 0.0001. Calprotectin](https://reader030.fdocuments.net/reader030/viewer/2022011819/5e9c088586015b2abd23494c/html5/thumbnails/34.jpg)
Ankylosing spondylitis: Prevalence of intestinal
inflammationIleocolonoscopyMielantis & Veys: 354 patients
Ileal inflammation was found in 40-80%
Ileal biopsies showed the same prevalence and type of abnormality as in ileal Crohn’s disease
![Page 35: IBD Stool tests: Are they useful? - Dr. Falk Pharma · IBD Stool tests: Are they useful? Ingvar Bjarnason ... The history of stool tests ... R E M I S S I O N Month p < 0.0001. Calprotectin](https://reader030.fdocuments.net/reader030/viewer/2022011819/5e9c088586015b2abd23494c/html5/thumbnails/35.jpg)
Intestinal inflammation in AS relatives
• 47 and 124 of 213 (58%) first degree relatives were studied for the presence of intestinal inflammation
41% of relatives had intestinal inflammation
Inheritance pattern = additive traitVariant component analyses
Gastroenterology. 2003;125:1598-1605
![Page 36: IBD Stool tests: Are they useful? - Dr. Falk Pharma · IBD Stool tests: Are they useful? Ingvar Bjarnason ... The history of stool tests ... R E M I S S I O N Month p < 0.0001. Calprotectin](https://reader030.fdocuments.net/reader030/viewer/2022011819/5e9c088586015b2abd23494c/html5/thumbnails/36.jpg)
Subclincial intestinal inflammation
• First degree relatives of patients with Crohn’s disease and AS have a “common”genetic abnormality that results intestinal inflammation
![Page 37: IBD Stool tests: Are they useful? - Dr. Falk Pharma · IBD Stool tests: Are they useful? Ingvar Bjarnason ... The history of stool tests ... R E M I S S I O N Month p < 0.0001. Calprotectin](https://reader030.fdocuments.net/reader030/viewer/2022011819/5e9c088586015b2abd23494c/html5/thumbnails/37.jpg)
Are AS and IBD patients related?
• The three following databases were assessed for the purpose of this study: • 1. Genealogic information on 610,920 people in Iceland during the past 11
centuries• 2. All living Icelanders diagnosed with AS (n=205), • 3. All living Icelanders diagnosed with IBD (n=1384).
• The relative risk for AS and IBD was assessed by comparison with 10.000 random sample from the Icelandic population. A cross-risk ratio was used to estimate possible relatedness between the AS and the IBD cases. A kinship coefficient (KC) for AS and IBD was estimated.
![Page 38: IBD Stool tests: Are they useful? - Dr. Falk Pharma · IBD Stool tests: Are they useful? Ingvar Bjarnason ... The history of stool tests ... R E M I S S I O N Month p < 0.0001. Calprotectin](https://reader030.fdocuments.net/reader030/viewer/2022011819/5e9c088586015b2abd23494c/html5/thumbnails/38.jpg)
![Page 39: IBD Stool tests: Are they useful? - Dr. Falk Pharma · IBD Stool tests: Are they useful? Ingvar Bjarnason ... The history of stool tests ... R E M I S S I O N Month p < 0.0001. Calprotectin](https://reader030.fdocuments.net/reader030/viewer/2022011819/5e9c088586015b2abd23494c/html5/thumbnails/39.jpg)
AS and IBD patients are related
• Relative risk IBD-first degree• IBD-IBD 4.4• AS-AS 96• AS IBD 3.3
• Relative risk falls off rapidly = compatible with additive genes• The KC of the IBD+AS patients was 12.9 x10-5 and control group (8.5 x10-
5) (p=0.0001). 1st – 7th meiosis, the KC of the IBD+AS patients remained significantly larger than the KC of the control group
SUMMARY
![Page 40: IBD Stool tests: Are they useful? - Dr. Falk Pharma · IBD Stool tests: Are they useful? Ingvar Bjarnason ... The history of stool tests ... R E M I S S I O N Month p < 0.0001. Calprotectin](https://reader030.fdocuments.net/reader030/viewer/2022011819/5e9c088586015b2abd23494c/html5/thumbnails/40.jpg)
Pathogenesis?
Similar genetic factors
AS
Crohn’s
Environmental factors?
Subclinical intestinal
inflammation
![Page 41: IBD Stool tests: Are they useful? - Dr. Falk Pharma · IBD Stool tests: Are they useful? Ingvar Bjarnason ... The history of stool tests ... R E M I S S I O N Month p < 0.0001. Calprotectin](https://reader030.fdocuments.net/reader030/viewer/2022011819/5e9c088586015b2abd23494c/html5/thumbnails/41.jpg)
Overall conclusionsFaecal tests provide direct functional data• Can be used for diagnostic screening (IBD v IBS)• Useful for assessing disease activity in IBD• Useful for assessing responses to treatment• Provide prognostic information in IBD (altering clinical practice)• Unlimited research potential!