Calprotectina fecal, marcador eficaz en la diferenciación de enfermedades inflamatorias intestinales y trastornos funcionales gastrointestinales / Faecal calprotectin, an useful marker in discriminating between inflammatory bowel disease and functional gastrointestinal disorders

INTRODUCCIÓN: La discriminación entre enfermedades inflamatorias intestinales (EII) y trastornos funcionales gastrointestinales es compleja debido a que pueden presentar cuadros clínicos similares. La calprotectina fecal (CPF) es un marcador inflamatorio útil para este fin y permite seleccionar a los pacientes que más se pueden beneficiar de someterse a una colonoscopia. El objetivo fundamental de este estudio fue valorar la utilidad de la CPF para diferenciar entre enfermedades orgánicas y funcionales. MATERIAL Y MÉTODOS: Se determinó la concentración de CPF de 264 pacientes que presentaban signos o síntomas gastrointestinales indicativos de enfermedad orgánica, y se calculó su precisión diagnóstica mediante el área bajo la curva a partir del diagnóstico final. RESULTADOS: Los pacientes con enfermedad orgánica presentaron valores de CPF mayores (mediana 254 μg/g; intervalo de confianza [IC] 95%, rango intercuartil 105-588,5) que el grupo con enfermedad funcional (95 μg/g; IC 95%, 47,25-243,92; p < 0,0001), así como el grupo con EII (270,85 μg/g; IC 95%, 96,85-674,00) obtuvo valores más elevados que el grupo con síndrome del intestino irritable (79,70; IC 95%, 36,50-117,25; p < 0,0001). Para un valor de corte de 150 μg/g se obtuvo un valor del área bajo la curva de 0,718 para discriminar entre enfermedad orgánica y funcional, y de 0,872 para discriminar entre síndrome del intestino irritable y EII. CONCLUSIÓN: En este estudio se corrobora el alto valor de la CPF en la evaluación de pacientes con sospecha de EII. La mejor eficacia diagnóstica se consigue con un cut-off de 150μg/g para la discriminación entre EII y síndrome del intestino irritable

INTRODUCTION: Diagnostic discrimination between inflammatory bowel disease (IBD) and functional gastrointestinal disorders is complex, as they cause similar signs and symptoms. Faecal calprotectin (FC) is a useful marker in this context, and can be used to select patients who will most benefit from colonoscopy. The aim of this study was to evaluate the utility of FC in discriminating between organic disease and functional disorders. MATERIAL AND METHODS: The study included 264 patients presenting with gastrointestinal complaints consistent with an organic pathology. FC levels were determined and diagnostic accuracy was assessed using the area under the curve obtained from the final diagnosis. RESULTS: Calprotectin levels in organic bowel disease patients were significantly higher (median 254 μ g/g; 95% confidence interval [CI], interquartile range 105-588.5) than in functional disease patients (95 μ g/g; 95% CI, 47.25-243.92) (P < .0001). Similarly, in patients with IBD, the values obtained were higher (270.85 μg/g; 95% CI, 96.85-674.00) than in those with irritable bowel syndrome (79.70μ g/g; 95% CI, 36.50-117.25) (P<.0001). For a cut-off of 150 μ g/g, FC had an area under the ROC curve to discriminate between organic and functional disease of 0.718, and 0.872 to discriminate between irritable bowel syndrome and IBD. CONCLUSION: Our study supports the importance of FC as a marker in the evaluation of patients with IBD. The best diagnostic accuracy is obtained at a cut-off value of 150μ g/g

Faecal calprotectin, an useful marker in discriminating between inflammatory bowel disease and functional gastrointestinal disorders. / Calprotectina fecal, marcador eficaz en la diferenciación de enfermedades inflamatorias intestinales y trastornos funcionales gastrointestinales.

INTRODUCTION: Diagnostic discrimination between inflammatory bowel disease (IBD) and functional gastrointestinal disorders is complex, as they cause similar signs and symptoms. Faecal calprotectin (FC) is a useful marker in this context, and can be used to select patients who will most benefit from colonoscopy. The aim of this study was to evaluate the utility of FC in discriminating between organic disease and functional disorders. MATERIAL AND METHODS: The study included 264 patients presenting with gastrointestinal complaints consistent with an organic pathology. FC levels were determined and diagnostic accuracy was assessed using the area under the curve obtained from the final diagnosis. RESULTS: Calprotectin levels in organic bowel disease patients were significantly higher (median 254µg/g; 95% confidence interval [CI], interquartile range 105-588.5) than in functional disease patients (95µg/g; 95% CI, 47.25-243.92) (P<.0001). Similarly, in patients with IBD, the values obtained were higher (270.85µg/g; 95% CI, 96.85-674.00) than in those with irritable bowel syndrome (79.70µg/g; 95% CI, 36.50-117.25) (P<.0001). For a cut-off of 150µg/g, FC had an area under the ROC curve to discriminate between organic and functional disease of 0.718, and 0.872 to discriminate between irritable bowel syndrome and IBD. CONCLUSION: Our study supports the importance of FC as a marker in the evaluation of patients with IBD. The best diagnostic accuracy is obtained at a cut-off value of 150µg/g.