Faecal Calprotectin (FCAL) is a protein that is released into the intestines in excess when there is any inflammation. Many people with irritable bowel syndrome (IBS) have unnecessary invasive hospital investigations before their condition is diagnosed. Use of FCAL testing may lead to a reduction in the number of investigations being requested for people with a high likelihood of an IBS diagnosis. This will:
• Improve the patient experience for those with IBS and reduce the number of patients undergoing invasive procedures within secondary care.
• Reduce outpatient referrals into secondary care.
• Increase the numbers accessing rapid diagnosis for IBS/IBD.
• Improve pathways for the management of IBS.
• Provide a structured programme to aid decision making in primary care.
FCAL testing is recommended by NICE as an option to help doctors distinguish between inflammatory bowel diseases, such as Crohn’s disease and ulcerative colitis, and non-inflammatory bowel diseases, such as irritable bowel syndrome.
The new IBS local pathway has two options for a patient i.e. if they are suffering from constipation then they are referred into the IBS pathway 2 (diet, medication physical activity etc). If a patient is suffering from diarrhoea then they will follow the IBS pathway 1 and be tested for FCAL. Only if the FCAL concentration >150 ug/g is the patient referred into the Inflammatory Bowel Disease Clinic (IBD). If the FCAL concentration is <60 ug/g they are referred onto the IBS pathway 2 and if the concentration is between 60 and 150 ug/g then the test is repeated after a 4 week interval. Please see flow charts below.