Alimentary TractDiagnostic value of faecal calprotectin in paediatric gastroenterology clinical practice
Introduction
Testing children with gastrointestinal symptoms while limiting the number of expensive and invasive procedures is a continuous challenge in paediatric clinical practice, e.g. to distinguish between functional disorders and a prodromal period of inflammatory bowel disease (IBD). A number of leukocyte-derived proteins have been proposed as non-invasive inflammation bio-markers, including eosinophilic cationic protein (ECP), elastase, esterase, myeloperoxidase, lysozyme, lactoferrin, and calprotectin [1], [2], [3]. Compared to these other candidates, calprotectin may offer performance advantages based on its biological characteristics. Specifically, this 36.5-kDa non-glycosylated polypeptide accounts for up to 60% of the cytosolic proteins found in neutrophils and macrophages [4], [5]. Additionally, calprotectin is stable in the stools for more than seven days which may be at least in part due to the high Ca2+ concentration in gut lumen, which makes it resistant to proteolytic degradation [2], [6]. Experiences with IBD children are encouraging and suggest that faecal calprotectin (FC) provides reliable information in the routine diagnostic work-up [7], [8]. However, data on FC in other common gastrointestinal paediatric diseases are still scarce. The purpose of this study was to assess FC values in common gastrointestinal diseases in paediatric clinical practice comparing them with those obtained in healthy subjects. In addition, reference FC values for healthy children were also presented for convenient use in clinical practice.
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Patients and methods
Children (age range 13–216 months) consecutively referred to our department for gastrointestinal symptoms were invited to participate in the study. Two hundred and eighty-one children with gastrointestinal diseases were enrolled. As controls, a faecal sample was obtained from 76 healthy children. These subjects were recruited from children visiting our department for routine examination and also from families of our staff. The exclusion criteria were the following: any known underlying chronic
Results
The FC values in healthy children and in patients with various gastrointestinal disorders are reported in Fig. 1 and in Table 2. In healthy children the median FC value was 28.0 μg/g (15–57 interquartile range). There were no differences in FC values attributable to age or sex. The 5th, 50th and 95th percentile FC values in healthy controls were 3.0, 28.0 and 95.3 μg/g, respectively. Children with active IBD, defined by clinical, endoscopic and histological parameters, showed significantly higher
Discussion
Despite the large amount of literature on calprotectin in recent years, data on children are incomplete, and the exact reference range for healthy children is still not completely defined. We reported it in this study indicating the 5th to 95th percentile FC value control range (3.0 and 95.3 μg/g, respectively). These data could be useful in clinical practice as reference values for children with ages ranging from 2 to 18 years. It has been previously shown that infants have higher FC values
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