Fecal calprotectin in pediatric inflammatory bowel disease: a systematic review.
BACKGROUND
Inflammatory bowel disease frequently begins during childhood or adolescence. Current tests and procedures for diagnosing and monitoring inflammatory bowel disease are invasive, uncomfortable and costly. Fecal calprotectin is an inflammatory marker tested in several studies including pediatric patients with inflammatory bowel disease.


METHODS
A search for articles published up to October 2011 was conducted using MEDLINE and EMBASE databases. We included original English-written articles referred to pediatric patients with inflammatory bowel disease and measured fecal calprotectin levels. We extracted data concerning fecal calprotectin levels in patients with inflammatory bowel disease and in the controls groups, sensitivity, specificity, positive and negative likelihood ratio.


RESULTS
Thirty-four studies were included. Fecal calprotectin levels of patients with inflammatory bowel disease are much higher than those of healthy controls or patients with functional disorders or other gastrointestinal diseases. The results vary greatly when taking all studies into consideration. Nevertheless, in cases of newly diagnosed and/or active inflammatory bowel disease, the results are more homogeneous, with high sensitivity and positive likelihood ratio, low negative likelihood ratio, but moderate specificity. Moreover, 50 μg/g seems to be the most proper cut-off point for the fecal calprotectin test.


CONCLUSIONS
The fecal calprotectin test could be used for supporting diagnosis or confirming relapse of inflammatory bowel disease in pediatric patients. A positive result could confirm the suspicion of either inflammatory bowel disease diagnosis or inflammatory bowel disease relapse, due to the high sensitivity of the test, but a negative result should not exclude these conditions, due to its moderate specificity.
Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Medical School, National and Kapodistrian University of Athens, 15b Agiou Thoma Street, 11527, Athens, Greece. i.d.kostakis@gmail.com
Ioannis D
ID
Kostakis
Kyriaki G
KG
Cholidou
Aristeidis G
AG
Vaiopoulos
Ioannis S
IS
Vlachos
Despina
D
Perrea
George
G
Vaos
D015415:Biomarkers / Q000032:analysis; D002648:Child; D003938:Diagnostic Techniques, Digestive System; D005243:Feces / Q000737:chemistry*; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000175:diagnosis* / Q000276:immunology / Q000378:metabolism*; D039841:Leukocyte L1 Antigen Complex / Q000032:analysis / Q000276:immunology / Q000378:metabolism*; D012680:Sensitivity and Specificity
D015415:Biomarkers; D039841:Leukocyte L1 Antigen Complex