J Crohns Colitis. 2020 May 11;jjaa093. doi: 10.1093/ecco-jcc/jjaa093. Online ahead of print.

Ferdinando D'Amico ^1 2, Stéphane Nancey ³, Silvio Danese ^1 4, Laurent Peyrin-Biroulet ²

Author information

¹Department of Biomedical Sciences, Humanitas University, Milan, Italy.

²Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France.

³Department of Gastroenterology, Hospices Civils de Lyon, Lyon-Sud Hospital, Pierre Benite, and Inserm U1111, CIRI, Lyon, France.

⁴IBD Center, Department of Gastroenterology, Humanitas Research Hospital, Rozzano -IRCCS-, Milan, Italy.

Abstract

Background and aims: Faecal calprotectin (FC) is a valid and non-invasive marker of mucosal inflammation. It is widely used both in clinical trials and daily clinical practice for patients with inflammatory bowel diseases but currently no accepted standardization for FC testing is available. The primary aim of our work was to provide a clinician's guide containing all the practical information on FC measurement in order to avoid any confounding factors, to minimize intra and inter-individual variability of the dosage, and to ensure a better and adequate interpretation of its result.

Methods: We conducted an accurate search of the scientific literature in PubMed/MEDLINE, EMBASE, and Cochrane database up to January 2020 in order to find all relevant and available articles on pre-analytical and analytical phases of FC measurement.

Results: FC testing is a multi-step procedure consisting of a pre-analytical phase aimed to collect and process the stool sample and a subsequent analytical phase whose purpose is the actual FC measurement. Several factors can influence test results determining false positives or false negatives. Importantly, this faecal marker is mostly used for patient follow-up and as a predictor of treatment response. For this reason, any altered data may affect the physicians' decisions, negatively impacting on patients' management.

Conclusions: Our work provides for the first time practical advices to minimize dosage variability, but further dedicated studies are needed to compare commercially available tests and identify the best tools for the most precise and accurate FC measurement.