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Sampling endoscopically normal large bowel mucosa from patients presenting with elevated faecal calprotectin levels is not clinically justified
  1. Newton A C S Wong1,
  2. Michael John Wallage2,
  3. Paul Virgo2,
  4. Hannah Lowes1
  1. 1 Cellular Pathology, Southmead Hospital, Bristol, UK
  2. 2 Immunology, Southmead Hospital, Bristol, UK
  1. Correspondence to Dr Newton A C S Wong, Cellular Pathology, Southmead Hospital, Bristol BS10 5NB, UK; Nacs.Wong{at}


Aims and methods Faecal calprotectin (FCP) measurement is used especially to investigate for inflammatory bowel disease (IBD). To assess the utility of sampling endoscopically normal large bowel among patients first presenting with elevated FCP, this study identified 115 such patients out of 652 patients with elevated FCP from approximately 6000 primary care tests processed over 15 months.

Results 23 cohort patients showed histologically abnormal large bowel biopsies. Only four cases demonstrated acute inflammation and two such patients only showed scattered cryptitis and did not develop IBD. A third patient demonstrated similar histology but, following repeat colonoscopy, her elevated FCP was attributed to small intestinal inflammation. Only the fourth patient’s large bowel biopsies showed features suggesting Crohn’s disease, but this represented an IBD detection rate out of 115 sets of large bowel biopsies of 0.9%.

Conclusions Sampling of endoscopically normal large bowel among patients first presenting with elevated FCP is not clinically justified.

  • inflammatory bowel diseases
  • pathology
  • surgical
  • Inflammation
  • diagnostic screening programmes

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  • Handling editor Runjan Chetty.

  • Contributors NACSW conceived the idea for this study. All authors collected the data. HL and NACSW analysed the data. All authors contributed to the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.