‘Poo factor’ puts some patients off faecal calprotectin tests

Not all patients with IBD share gastroenterologists’ enthusiasm for faecal calprotectin testing, with the ‘poo factor’ still prevailing and a blood test preferable to many.

According to a survey of patients’ perceptions regarding faecal calprotectin, more than a third (37%) found the stool test challenging – moderate, difficult or very difficult – mostly due to specimen collection as well as the process of delivering the specimen to the lab or hospital.

The study, based on responses from more than 500 patients with IBD across centres in Australia as well as the UK, Spain and Norway, found that 63% of IBD patients who had an experience of the test rated it as very easy or easy.

However, more than half (55%) of all the patients preferred blood tests over faecal testing if they were given the choice.

When given an option between faecal testing and endoscopy, 66% opted for the non-invasive faecal testing.

The researchers, including Dr Ray Boyapati, a gastroenterologist at Monash Health in Victoria, said patients’ views on improving specimen collection kits and instruction leaflets may be useful in order to improve acceptability of the test.

“Optimising the uptake of our currently available non-invasive tools is critical and further qualitative studies are needed to explore potential improvements to FC testing delivery and uptake,” they said.

And the results may help inform other tests in the future.

“The results of blood testing preference amongst IBD patients in our study may also be relevant to other projects exploring novel faecal biomarkers in IBD including faecal miRNAs and organic metabolites; studies where the acceptability and clinical uptake of these novel faecal markers are yet to be explored,” the study said.

Dr Boyapati told the limbic the research suggested patients with a shorter duration of disease were more likely to find faecal calprotectin testing challenging.

“This suggests better early education on sample collection and improved logistics with drop-off facilities may help improve patient’s perception of these tests, especially early in the disease.”

He said there was no current blood test that could boast FC’s sensitivity and specificity.

“This means that the real question is endoscopy versus faecal calprotectin, and we found that patients preferred non-invasive faecal calprotectin testing to invasive endoscopy. As clinicians, FC provides us with an opportunity to reduce overall health costs and potential risks to the patient from unnecessary endoscopy.”

He added that the main challenge with FC testing was the out-of-pocket cost.

“Many of our patients cannot afford FC testing given it is not MBS subsidised, and this poses a real problem given its proven clinical utility as a diagnostic and monitoring tool. GESA is currently preparing a MSAC submission to have FC subsidised, and we in the IBD community eagerly await the outcome.”

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