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Waugh N, Cummins E, Royle P, et al. Faecal calprotectin testing for differentiating amongst inflammatory and non-inflammatory bowel diseases: systematic review and economic evaluation. Southampton (UK): NIHR Journals Library; 2013 Nov. (Health Technology Assessment, No. 17.55.)

Cover of Faecal calprotectin testing for differentiating amongst inflammatory and non-inflammatory bowel diseases: systematic review and economic evaluation

Faecal calprotectin testing for differentiating amongst inflammatory and non-inflammatory bowel diseases: systematic review and economic evaluation.

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Appendix 1Comparison of ulcerative colitis, Crohn’s disease, irritable bowel syndrome and coeliac disease

TABLE 74

Comparison between UC, CD, IBS and coeliac disease

UCCDIBSCoeliac disease
AgeAnyAnyAny, but more in youngAny age
Adults: peak onset in third or fourth decade
GenderM = FM = FFemale preponderanceIn adults, females are affected twice as often as males
Population distributionIncidence in Western countries: 10–20 per 100,000
Prevalence in Western countries: 100–200 per 100,000
Incidence in Western countries: 5–10 per 100,000
Prevalence in Western countries: 50–100 per 100,000
About 20% but only 10% consult GPsWorldwide but more common in northern Europe
Prevalence in the UK approximately 1% but 50% of them are asymptomatic (include both undiagnosed ‘silent’ cases and ‘latent’ cases, who later develop coeliac disease)
Ethnic groupAnyAny; more common in Ashkenazi JewsNot reportedNot mentioned
Genetic factorsHLA-DR103 associated with severe diseaseCARD 15/NOD-2 mutations predisposeNot reportedGenetically susceptible individuals intolerant to wheat gluten and similar proteins found in rye, barley and, to oats:
Associated with other HLA-linked autoimmune disorders and with certain other diseases
Risk factorsMore common in non-/ex-smokers; appendectomy protectsMore common in smokers (RR = 3)History of psychological stressNot mentioned as risk factors but coeliac disease associated with other HLA-linked autoimmune disorders and with certain other diseases, such as IDDM, thyroid disease, primary biliary cirrhosis, IBD, Sjögren’s syndrome, IgA deficiency, pernicious anaemia, sarcoidosis, myasthenia gravis, Down’s syndrome, etc.
DiagnosisClinical confirmed by biopsyBiopsyClinical. Diagnosis supported by symptoms for more than 6 months; worsened by stress; FBC and ESR normalEndoscopic small bowel biopsy is the gold standard (villous atrophy):
IgA antiendomysial antibodies by immunofluorescence:
haematology (micro- and macrocytic anaemia) and biochemistry (low Ca, Mg, total protein, albumin and vitamin D)
Anatomical distributionColon only; begins at anorectal margin with variable proximal extension
Proctitis (rectum); proctosigmoiditis (rectum and sigmoid colon); pancolitis (whole colon)
Any part of GI tract; perianal disease common; patchy distribution – ‘skip lesions’
Sites involved (in order of frequency): terminal ileum and right side of colon, colon alone, terminal ileum alone, ileum and jejunum
ColonoscopySmall bowel
Extraintestinal manifestationsCommonCommonAssociated with other conditions such as dysmenorrhoea, non-ulcer dyspepsia, ‘fibromyalgia’Common
PresentationBloody diarrhoea
Proctitis – rectal bleeding, mucus discharge, tenesmus
Proctosigmoiditis – bloody diarrhoea with mucus; some develop fever, lethargy and abdominal discomfort
Extensive pancolitis – bloody diarrhoea with passage of mucus. Severe case – anorexia, malaise, weight loss and abdominal pain, patient is toxic with fever, tachycardia and signs of peritoneal inflammation
Variable; pain, diarrhoea, weight loss all common
Ileal CD: there may be subacute or even acute intestinal obstruction. Diarrhoea – watery but no blood or mucus
Crohn’s colitis: identical to UC but rectum spared and presence of perianal disease. Many presents with symptoms of both small bowel and colonic disease. In few, isolated perianal disease, vomiting from jejunal strictures and severe oral ulceration
Recurrent colicky abdominal pain or cramping, relieved by defecation
Abdominal distension
Episodes of diarrhoea but can have more of a constipation pattern
Patients well, no weight loss
Depends on age of onset
Infancy: diarrhoea, malabsorption and failure to thrive – symptoms starts after weaning on to cereals
Older children: non-specific features like delayed growth; malnutrition, mild abdominal distension; growth and pubertal delay
Adults: Highly variable, depending on the severity and extent of small bowel involvement. Some florid malabsorption, others non-specific symptoms, such as tiredness, weight loss, folate or iron-deficiency anaemia. Oral ulceration, dyspepsia and bloating; mild undernutrition and increased risk of osteoporosis
HistologyInflammation limited to mucosa; crypt distortion, cryptitis, crypt abscesses, loss of goblet cellsSubmucosal or transmural inflammation common; deep fissuring ulcers, fistulas; patchy changes; granulomasNormalSubtotal villous atrophy
Sometime villous appears normal but there may be excess numbers of intraepithelial lymphocytes

HLA, human leucocyte antigen; IDDM, insulin-dependent diabetes mellitus.

Source: Davidson’s Principles and Practice of Medicine, 21st edn.195

Copyright © Queen’s Printer and Controller of HMSO 2013. This work was produced by Waugh et al. under the terms of a commissioning contract issued by the Secretary of State for Health. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK.

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Bookshelf ID: NBK261307

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