Pediatr Gastroenterol Nutr. 2021 Apr 1;72(4):617-640. doi: 10.1097/MPG.0000000000003046.

Carmen Ribes Koninckx ¹, Ester Donat ¹, Marc A Benninga ², Ilse J Broekaert ³, Frederic Gottrand ⁴, Kaija-Leena Kolho ⁵, Paolo Lionetti ⁶, Erasmo Miele ⁷, Rok Orel ⁸, Alexandra Papadopoulou ⁹, Corina Pienar ¹⁰, Michela G Schäppi ¹¹, Michael Wilschanski ¹², Nikhil Thapar ^13 14

Author information

• ¹Department of Paediatric Gastroenterology, Hepatology and Nutrition, La Fe University Hospital Valencia, Spain.
• ²Department of Paediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
• ³Department of Paediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
• ⁴Department of Paediatric Gastroenterology, Hepatology and Nutrition, CHU Lille, University Lille, France.
• ⁵Children's Hospital, University of Helsinki, Helsinki, Finland and Tampere University, Tampere, Finland.
• ⁶Department NEUROFARBA, University of Florence - Meyer Children's Hospital, Florence.
• ⁷Department of Translational Medical Science, Section of Pediatrics, University of Naples "Federico II", Naples, Italy.
• ⁸Department of Gastroenterology, Hepatology and Nutrition, University Children's Hospital, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
• ⁹Division of Gastroenterology and Hepatology, First Department of Paediatrics, University of Athens, Children's hospital «Agia Sofia», Athens, Greece.
• ¹⁰Department of Paediatrics, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania.
• ¹¹Paediatric Centre, Clinique des Grangettes and Centre Médical Universitaire, Geneva, Switzerland.
• ¹²Paediatric Gastroenterology Hadassah Hebrew University Medical Centre, Jerusalem, Israel.
• ¹³Neurogastroenterology and Motility, UCL Great Ormond Street Institute of Child Health and Department of Gastroenterology, Great Ormond Street Hospital, London, UK.
• ¹⁴Gastroenterology, Hepatology and Liver Transplant, Queensland Children's Hospital, Brisbane, Australia.

Abstract

Objectives: The aim of the study was to review the evidence regarding the clinical use and value of fecal calprotectin (FC) measurements in different gastrointestinal disorders in children.

Methods: A literature search was conducted in the PubMed, MEDLINE, EMBASE, and Cochrane databases until October 31, 2019. Subtopics were identified and each assigned to individual authors.

Results: A total of 28 recommendations were voted on using the nominal voting technique. Recommendations are given related to sampling, measurement methods, and results interpretation. The 14 authors anonymously voted on each recommendation using a 9-point scale (1 strongly disagree to 9 fully agree). Consensus was considered achieved if at least 75% of the authors voted 6, 7, 8, or 9.

Conclusions: Consensus was reached for all recommendations. Limitations for the use of FC in clinical practice include variability in extraction methodology, performance of test kits as well as the need to establish local reference ranges because of the influence of individual factors, such as age, diet, microbiota, and drugs. The main utility of FC measurement at present is in the diagnosis and monitoring of inflammatory bowel disease (IBD) as well as to differentiate it from functional gastrointestinal disorders (FAPDs). FC, however, has neither utility in the diagnosis of infantile colic nor to differentiate between functional and organic constipation. A rise in FC concentration, may alert to the risk of developing necrotizing enterocolitis and help identifying gastrointestinal involvement in children with Henoch-Schönlein purpura. FC measurement is of little value in Cow's Milk Protein Allergy, coeliac disease (CD), and cystic fibrosis. FC does neither help to distinguish bacterial from viral acute gastroenteritis (AGE), nor to diagnose Helicobacter Pylori infection, small intestinal bacterial overgrowth (SIBO), acute appendicitis (AA), or intestinal polyps.