Endoscopy in patients with Digestive Diseases

Digestive complaints are commonly seen in patients in clinical practice and many undergo endoscopy for further evaluation. However, symptoms may arise from a variety of disorders including functional dyspepsia and irritable bowel syndrome and the potential risk of invasive procedures must be balanced against the benefit of detecting a significant organic disease.

Patient selection based on symptoms alone is unfortunately not reliable both for patients with dyspepsia and with lower abdominal symptoms. Around half of the patients with peptic ulcer disease or esophagitis at endoscopy will be misclassified when presenting with epigastric pain. Accordingly, main pathologies (ulcer, malignancy) are initiated in only a minority of dyspeptic patients. Similarly, in average-risk patients with non-specific lower abdominal symptoms, the overall yield of colonoscopy is low and may be like an average-risk screening population.

The efficient use of endoscopic procedures is paramount to ensure high-quality cost-effective medical care. However, the low specificity of current guidelines of appropriateness substantially reduces the predictive value of relevant endoscopic findings. The benefit of a diagnostic test for inclusion to appropriateness criteria might, therefore, be useful by increasing diagnostic yield.

Calprotectin is an abundant, calcium- and zinc-binding protein found mainly in neutrophils. It correlates well with neutrophil infiltration of the intestinal mucosa and when measured in faeces it is considered as an established biological marker of intestinal inflammation throughout the gastrointestinal tract. It has proven highly useful for the identification of inflammatory bowel disease and for distinguishing between organic and functional disorders of the colon and similar the upper intestinal tract although.

The combined use of EPAGE (European Panel on the Appropriateness of Gastrointestinal Endoscopy) scoring and faecal calprotectin testing led to superior risk stratification in patients with abdominal complaints and increased diagnostic yield in patients requiring endoscopy. This would especially be useful in open-access health care systems when patients are referred for endoscopy by non-gastroenterologists.

Measurement of faecal calprotectin is useful for identifying clinically-significant endoscopic findings in patients with abdominal complaints and when combined with appropriateness guidelines improve the limited diagnostic yield of EPAGE criteria.

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