Rendek Zlatica, Falk Magnus, Grodzinsky Ewa, Kechagias Stergios, Hjortswang Henrik
Department of Biomedical and Clinical Sciences Linköping University Linköping Sweden.
Department of Health, Medicine and Caring Sciences Linköping University Linköping Sweden.
JGH Open. 2023 Sep 22;7(10):708-716. doi: 10.1002/jgh3.12972. eCollection 2023 Oct.
To investigate the diagnostic accuracy of fecal calprotectin (FC) for inflammatory bowel disease (IBD) and organic gastrointestinal disease (OGID) in primary care. To examine the association with demographic factors, symptoms and concomitant medical therapy.
A retrospective analysis of data on all semiquantitative FC tests from individuals ≥18 years conducted in primary care in Östergötland County in 2010. A 5-year follow-up with inclusion of new gastrointestinal diagnoses.
A total of 1293 eligible patients were included. IBD was found in 8.8% and other OGID in 30.8% of patients with positive FC. Positive FC was associated with diarrhea, age >60 years, duration <3 months, use of nonsteroidal anti-inflammatory drug (NSAID), and proton pump inhibitor (PPI). Predictors of IBD were positive FC, diarrhea, rectal bleeding, and male sex; predictors of OGID positive FC, age >35 years, abnormal clinical findings, and duration <3 months. FC yielded the highest sensitivity and negative predictive value compared with demographic factors, symptoms, and duration. Use of NSAID and PPI showed a marginal increase in the sensitivity, positive predictive value, and decrease in the specificity of FC. Within 5 years, 4.0% had a new gastrointestinal diagnosis among patients with positive FC (0.6% IBD).
FC reliably rules out IBD and contradicts the presence of other OGID in primary care patients. Positive FC test together with other predictors, such as diarrhea, rectal bleeding, short duration, or age >35 years, should encourage a prioritized investigation. Use of NSAID, PPI, and ASA may affect the diagnostic accuracy of FC for IBD and OGID.
探讨粪便钙卫蛋白（FC）对基层医疗中炎症性肠病（IBD）和器质性胃肠疾病（OGID）的诊断准确性。研究其与人口统计学因素、症状及伴随药物治疗的相关性。
对2010年在东约特兰郡基层医疗中进行的所有≥18岁个体的半定量FC检测数据进行回顾性分析。进行为期5年的随访，并纳入新的胃肠道诊断病例。
共纳入1293例符合条件的患者。FC检测阳性的患者中，IBD的检出率为8.8%，其他OGID的检出率为30.8%。FC阳性与腹泻、年龄>60岁、病程<3个月、使用非甾体抗炎药（NSAID）和质子泵抑制剂（PPI）相关。IBD的预测因素为FC阳性、腹泻、直肠出血和男性；OGID的预测因素为FC阳性、年龄>35岁、临床检查异常和病程<3个月。与人口统计学因素、症状和病程相比，FC具有最高的敏感性和阴性预测值。使用NSAID和PPI使FC的敏感性、阳性预测值略有增加，特异性略有降低。在5年内，FC检测阳性的患者中有4.0%被诊断为新的胃肠道疾病（0.6%为IBD）。
FC可可靠地排除基层医疗患者中的IBD，并与其他OGID的存在相矛盾。FC检测阳性以及腹泻、直肠出血、病程短或年龄>35岁等其他预测因素应促使进行优先检查。使用NSAID、PPI和阿司匹林可能会影响FC对IBD和OGID的诊断准确性。
