Faecal Calprotectin Care Pathway

Review in progress

Disclaimer: The guidance contains helpful primary care information for management of referrals and up to date referral criteria. These guidelines are locality specific to best reflect local services. This guidance does not override or replace the individual responsibility of healthcare and social care professionals involved in the delivery of care to make informed professional judgements appropriate to the circumstances of the individual.

Scope

This guidance refers to:

  • patients aged 18-60 years who present with diarrhoea predominant lower gastrointestinal symptoms in whom you suspect IBS or IBD

This guidance does not cover:

  • patients under the age of 18 or over the age of 60
  • patients where colorectal cancer is suspected (see red flags) or when there is diagnostic certainty

Assessment

  • Calprotectin is a protein released into the gastrointestinal tract when it is inflamed, such as in inflammatory bowel disease (IBD; Crohn's disease and ulcerative colitis) it is stable protein, so can be detected in the stool by laboratory assay.
  • Elevated levels of faecal calprotectin are found in IBD.
  • By contrast, in functional disorders of the gastrointestinal tract, such as the irritable bowel syndrome (IBS) faecal calprotectin levels are normal.
  • Clinically, it is often very difficult to be able to distinguish IBS form IBD based on symptoms, signs and blood tests. Here, faecal calprotectin can be used as a biomarker to support your assessment.
  • A care pathway has been developed for the use of faecal calprotectin in primary care. No biomarker test is 100% accurate but we have shown this care pathway to be effective and safe in supporting your clinical decision making.

Red Flags

Patients meeting the following criteria should be referred via the lower GI 2ww pathway:

  • aged 40 and over with unexplained weight loss and abdominal pain or
  • aged 50 and over with unexplained rectal bleeding or
  • aged 60 and over with:
    • iron deficiency anaemia or
    • changes in their bowel habit, or
  • tests show occult blood in their faeces
  • adults with a rectal or abdominal mass. [new 2015]
  • under 50 with rectal bleeding and any of the following unexplained symptoms or findings:
    • abdominal pain
    • change in bowel habit
    • weight loss
    • iron deficiency anaemia. [new 2015]

Investigations

Undertake the following to aid diagnosis, inform management or prior to referral:

Faecal calprotectin should be requested alongside other tests such as:

  • FBC, urea and electrolytes, C-reactive protein, Coeliac screen, TFT, LFTs, Stool culture including clostridium difficile

Management

What should I do with the faecal calprotectin result?

See Faecal Calprotectin Care Pathway

1. Faecal calprotectin <100mcg/g

  • IBS is 98% likely
  • Treat as IBS and review in 6 weeks,

See: NICE IBS Pathway

2. Faecal Calprotectin 100mcg/g

  • Repeat the test within 2 weeks
  • If repeat test <100mcg/g, IBS is likely, see above
  • If repeat test 100-250mcg/g, refer gastroenterology routinely
  • If repeat test >250mcg/g, IBD 50% likely, refer urgently to gastroenterology

Referral

Referral Criteria

  • Refer via the lower GI 2ww pathway patients:
    • aged 40 and over with unexplained weight loss and abdominal pain or
    • aged 50 and over with unexplained rectal bleeding or
    • aged 60 and over with:
      • iron deficiency anaemia or
      • changes in their bowel habit, or
    • tests show occult blood in their faeces
    • adults with a rectal or abdominal mass. [new 2015]
    • under 50 with rectal bleeding and any of the following unexplained symptoms or findings:
      • abdominal pain
      • change in bowel habit
      • weight loss
      • iron deficiency anaemia. [new 2015]
  • Routine referral to Gastroenterology - If repeat test 100-250mcg/g
  • Urgent referral to Gastroenterology - If repeat test >250mcg/g

Referral Requirements

  • All referrals should be accompanied by the FCP result

Referral Instructions

  • e-Consultation is not currently available for this specialty
  • Referrals should be made via ICG to TRISH (if training has been undertaken) - See user guides (EMIS & S1) for further information.
  • For those Practices who have not received ICG training referral is via eRS to gastroenterology clinic: inflammatory bowel disease
  • Please identify speciality and clinic type

Supporting Information

Shared Decision Making

  • Patients have a right to make decisions about their care and should be fully informed about the options they face. They should be provided with reliable evidence-based information on the likely benefits and harms of interventions or actions, including any uncertainties and risks, eliciting their preferences and supporting implementation.

Patient Information/Public Health/Self Care

Evidence/Additional Information

Assurance & Governance

  • This guidance was developed on: 05.2017
  • This guidance was ratified by: The OSCAR Assurance Group
  • Date ratified: 05.2017
  • Publication Date: 05.2017
  • Last Updated: 02.2018
  • Review Date: 05.2019
  • Ref No: GA4 - 05.2017
Any feedback or suggestions to improve this guidance should be sent to: oscaradmin@this.nhs.uk
Only the electronic version is maintained, once printed this is no longer a controlled document

 

Home > Care Pathways > Gastroenterology* > Faecal Calprotectin Care Pathway