(IBD, IBS, Coeliac disease)
Inflammatory bowel disease
Irritable bowel syndrome (non-inflammatory functional bowel disease)
Gastrointestinal disease - example pathway for differentiating between GI symptoms
Urgent need to visit toilet
Blood in stool
Full blood count
Thyroid stimulating hormone
Coeliac disease and patient on gluten-free diet
What are the benefits of early diagnosis?
Testing for coeliac disease can help to:
- Ensure effective and timely treatment6
- Prevent other autoimmune processes and reverse intestinal damage16
- Determine if referral to a specialist is appropriate6
- Reduce patient symptoms and improve quality of life6
- Alleviate the symptoms of coeliac disease-associated complications16-21
- Avoid unnecessary symptoms and costly interventional procedures6
How can tests be used to personalise care?
Tissue transglutaminase can help:
- Monitor adherence in patients on a gluten-free diet6
Faecal calprotectin testing can help:
- Identify Crohn's disease patients with active disease (higher endoscopic activity, CDAI and CDEI)22,23
- Identify Crohn's disease patients with increased risk of relapse24,25
- Identify ulcerative colitis patients with increased risk of relapse24-26
- Identify which Crohn's disease patients are responding to treatment with biologicals23
ASCA testing can help:
- Identify patients with Crohn's disease who are at risk of complications such as stricturing or penetrating disease, ileal involvement, perianal disease, or surgery (ASCA IgG)9,10
- Differentiate Crohn's disease from ulcerative colitis in patients with a diagnosis of IBD-unclassified in combination with pANCA)11,17
How can faecal calprotectin lead to cost savings in your local CCGs?31
What do the experts say?
- Waugh N, et al. Health Technology Assessment 2013; 17.
- Green PHR, et al. Am J Gastroenterol 2001; 96(1): 126-131.
- Jatla M, et al. Pract Gastroenterol 2008; 32(4): 18-34.
- Van Assche G, et al. J Crohns Colitis 2010; 4: 7-27.
- National Health Service: Irritable bowel syndrome (IBS) - Symptoms. 2013. Available from: http://www.nhs.uk/Conditions/Irritable-bowel-syndrome/Pages/Symptoms.aspx; last accessed May 2014.
- National Institute for Health and Care Excellence. Coeliac Disease: recognition, assessment and management (NG20). 2015. London: National Institute for Health and Care Excellence.
- National Institute for Health and Care Excellence. NICE pathways - Irritable bowel syndrome in adults. Available from http://pathways.nice.org.uk/pathways/irritable-bowel-syndrome-in-adults; last accessed May 2014.
- Burri E and Beglinger C. Swis Med Wkly 2012; 142: w13557.
- IBD standards - standards for the healthcare of people who have inflammatory bowel disease (IBD). Available from http://www.ibdstandards.org.uk/uploaded_files/IBDstandards.pdf; last accessed July 2015.
- Crohn's and colitis UK. Final report of a study entitled 'An examination of aspects of the occurrence natural history and consequences of inflammatory bowel diseases utilising available electronic records'. 2010-2012. Available from http://www.crohnsandcolitis.org.uk/Resources/CrohnsAndColitisUK/Research%20Awards%20-%20Medical%20Awards/dr-timothy-card-final-report.pdf; last accessed July 2015.
- National Institute for Health and Care Excellence. Irritable bowel syndrome in adults - Diagnosis and management of irritable bowel syndrome in primary care (CG61). 2008. London: National Institute for Health and Care Excellence.
- National Institute for Health and Care Excellence. Faecal calprotectin diagnostic tests for inflammatory disease of the bowel (DG11). 2013. London: National Institute for Health and Care Excellence.
- Harkness EF, et al. BMC Fam Pract 2013; 14: 92.
- Gujral N, et al. World J Gastroenterol 2012; 18(42): 6036-6059.
- Coeliac UK. Available from https://www.coeliac.org.uk/coeliac-disease/myths-about-coeliac-disease/; last accessed July 2015.
- AGA Institute. Gastroenterology 2006; 131: 1977-1980.
- Holmes GKT. Arch Dis Child 2002; 87: 495-499.
- Mohseninejad L, et al. Eur J Health Econ 2012; November.
- Rastogi A, et al. Indian J Endocrinol Metab 2012; 16(5): 780-785.
- Shah S and Leffler D. Womens Health (Lond Engl) 2010; 6(5): 753 -766.
- Szodoray P, et al. Rheumatol Int 2004; 24(5): 278-282.
- Schoepfer AM, et al. Am J Gastroenterology 2013; 108: 1744-1753.
- Sipponen T, et al. Inflamm Bowel Dis 2008; 14: 40-6.
- Tibble JA, et al. Gastroenterology 2000; 119: 15-22.
- Gisbert JP, et al. Inflamm Bowel Dis 2009; 15: 1190-8.
- De Vos M, et al. Inflamm Bowel Dis 2013; 19: 2111-7.
- Ryan JD, et al. Ailment Pharmacol Ther 2013; 38: 274-83.
- Zhang Z, et al. Dig Dis Sci 2012; 57(11): 2944-2954.
- Levine A, et al. J Pediatr Gastroenterol Nutr 2014; 58: 795-806.
- Joossens S, et al. Gastroenterology 2002; 122: 1242-7.
- Harvey Walsh. NHS HES data 2013/2014.
- Hunt R, et al. World Gastroenterology Organisation Global Guidelines: coping with common GI symptoms in the community. Available from http://www.worldgastroenterology.org/assets/export/userfiles/2013_FINAL_Common%20GI%20Symptoms%20_long.pdf; last accessed June 2015.
- Turner D, et al. J Pediatr Gastroenterol Nutr 2014; 55: 340-361.
- Ruemmele FM, et al. J Crohns Colitis 2014; doi: 10.1016/j.crohns.2014.04.005.
- KovÃ¡cs M, et al. World J Gastroenterol 2014; 20(17): 4873-4882.
- Zhou N,et al. J Zhejiang Univ Sci B 2011; 12: 280-286.
- Burakoff R. J Clin Gastroenterol 2004; 38: S41YS43.
- Bousvaros A, et al. J Pediatr Gastroenterol Nutr 2007; 44(5): 653-74.