Can testing stool samples in children help determine choice of treatment?

What was this research looking at? 

Testing poo for markers of inflammation has boosted our ability to diagnose Crohn’s Disease early in children. While effective treatments exist, some children need to try several different types before they find the one that works for them. This has an adverse effect on their quality of life and risks the development of complications.  

The researchers recruited children with suspected Crohn’s or Colitis to the study. The study involved collecting a poo sample before diagnosis, then every two weeks once they had started treatment. The samples could be collected by parents at home and sent in the post to a laboratory for testing. The researchers measured the level of calprotectin, a protein contained in white blood cells which can show if you have inflammation in your gut, in the samples.  

The researchers suggested that looking at calprotectin levels could determine whether or not a treatment was working soon after it was started. This would allow clinicians to identify children that need to be put on stronger treatments earlier. 

What did the researchers find?

Testing calprotectin very shortly after starting treatment and comparing it to a pre-treatment level was not definitely predictive of treatment success in this study. However, there was clear evidence of calprotectin falling to normal levels during successful treatment.

The researchers faced challenges as providing and posting multiple samples in a short time frame was difficult for some participants.

Further studies looking at calprotectin as a predictor that treatments were working would be helpful but should consider using point-of-care testing where possible.

What do the researchers think this could mean for people with Crohn's and Colitis?

The researchers hope that future research could look at how to make it easier for children, young people and their families to monitor disease activity at home.  

Who is leading this research? Dr Astor Rodrigues, John Radcliffe Hospital/University of Oxford
Project cost: £10,000 (jointly funded by BSPGHAN) 
Duration: 18 months
Official title of application: Early measurement of faecal calprotectin as a predictor of primary non-response to treatment in paediatric Crohn’s Disease: a pilot study (PSG16-3)