Elevated Fecal Calprotectin Linked to Often Unnecessary Colonoscopy in Pediatric H. Pylori, with Jessica Lat, MD

A study presented at the 2024 Annual North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) Meeting in Hollywood, Florida, from November 7 to 9, 2024 demonstrated a clear association of elevated fecal calprotectin with often unnecessary colonoscopy among children with helicobacter (H.) pylori infection. During the meeting, HCPLive sat down with investigator Jessica Lat, MD, a Pediatrics Resident at Maimonides Medical Center, to discuss the findings of this retrospective analysis.

“What we are trying to show in our study is that in our setting…where we have a high immigrant population, we should treat the H Pylori first and see if the fecal calprotectin goes down before we go and proceed with the colonoscopy,” Lat said.

Lat and colleagues aimed to examine the relationship between fecal calprotectin levels in children with H. pylori infection and the risk of undergoing colonoscopy. Investigators studied a high immigrant population community in Brooklyn and included patients aged 6 – 18 years with a history of esophagogastroduodenoscopy (EGD) or HP stool/breath testing. Patients had a documented fecal calprotectin level within 6 months before their EGD or stool-breath screening. The team excluded patients with IBD, polypoid disease, or other intestinal conditions that may increase fecal calprotectin.

Investigators collected patient records, including endoscopic, histologic, and lab data for fecal H. pylori testing and gastric biopsy results. Among 129 patients, 28.7% tested positive for an H. pylori infection and 71.3% tested negative, with the groups having no significant differences regarding age, sex, race, or body mass index (BMI). The fecal calprotectin was elevated significantly in patients who tested positive for H. pylori (241.2; 95% CI, 161.0 – 321.3 vs 88.1; 95% CI, 59.1 – 117.0; P < .001).

The team broke fecal calprotectin levels into 3 ranges: < 50, 50 – 150, and > 150. They observed a greater percentage of patients with a higher fecal calprotectin level (> 150; 77.1%) underwent colonoscopy than those with lower fecal calprotectin levels (< 50, 51.6% and 50 – 100, 56.3%) (P = .044).

Lat said if a patient shows elevated fecal calprotectin, the standard is a colonoscopy, which could point to irritable bowel disease or another disease. However, this is not always necessary. In communities with high immigration or low socio-economic status, where the H. pylori prevalence is greater, Lat recommends to treat for H. pylori first.

“It's warranted that if you're in a region where the prevalence of h pylori may be high, then possibly what we can do is treat the H. Pylori first test and then have a colonoscopy,” Lat said. “So, we are recommending if there's no there are no other significant findings that point us to anything else other than h pylori, then possibly let's test H. pylori first.”

References

^{Lat, J, Aronson, S, Villalba-Davila, P, et al. H. Pylori Infection Associated Fecal Calprotectin Elevation Associated with Higher Likelihood Of Colonoscopy. Presented at NASPHGAN 2024 in Hollywood, Florida, from November 7 – November 9, 2024.}