• Trifa A. Mahmood College of Medicine, University of Sulaimani, Kurdistan Region, Iraq. & Kurdistan Centre of Gastroenterology and Hepatology (KCGH), Sulaymaniyah, Kurdistan Region, Iraq.
  • Mohammed O. Mohammed College of Medicine, University of Sulaimani, Kurdistan Region, Iraq. & Kurdistan Centre of Gastroenterology and Hepatology (KCGH), Sulaymaniyah, Kurdistan Region, Iraq.
  • Dana T. Gharib Kurdistan Centre of Gastroenterology and Hepatology (KCGH), Sulaymaniyah, Kurdistan Region, Iraq.
  • Taha A. Mohamad College of Medicine, University of Sulaimani, Kurdistan Region, Iraq. & Kurdistan Centre of Gastroenterology and Hepatology (KCGH), Sulaymaniyah, Kurdistan Region, Iraq.
  • Muhsin A. Mohammed Kurdistan Centre of Gastroenterology and Hepatology (KCGH), Sulaymaniyah, Kurdistan Region, Iraq.
  • Araz L. Rahim Kurdistan Centre of Gastroenterology and Hepatology (KCGH), Sulaymaniyah, Kurdistan Region, Iraq.



Inflammatory bowel disease, Fecal calprotectin, Colonoscopy, Sulaimaniyah



The difficulty in differentiating functional gastrointestinal disorders and inflammatory bowel diseases in patients presenting with abdominal symptoms direct us to the use of fecal inflammatory biomarkers that are specific to intestinal inflammation.


To assess the benefits of fecal calprotectin (FC) in patients presenting with lower abdominal symptoms. Also, correlating the FC and CRP titer with abdominal pain severity.

Patients and Methods

Prospective cross-sectional study in Kurdistan Center for Gastroenterology and Hepatology (KCGH), Sulaimaniyah city, Northern Iraq. A total of 174 patients with IBS according to Rome IV criteria, who visited KCGH, met the inclusion criteria. FC titer measured before colonoscopy appointment, abdominal pain severity scored according to visual scale, and colonoscopy performed by a specialized gastroenterologist. 


The FC level was below 50ug/g for 91.3% of patients with normal endoscopy; all of the IBD cases had FC level above 100ug/g. Seven of the eight patients with non-inflamed polyp or diverticuli had an FC level of less than 50ug/g. Moreover, in this study, the CRP level is also significantly higher among IBD cases than in patients with normal colonoscopy. 


FC titer is a useful measure before the decision for colonoscopy especially in cases not having alarm symptoms and other comorbidities. FC and CRP level is associated with the severity of abdominal pain.


Holtedahl K, Vedsted P, Borgquist L, Donker GA, Buntinx F, Weller D, et al. Abdominal symptoms in general practice: Frequency, cancer suspicions raised, and actions taken by GPs in six European countries. Cohort study with prospective registration of cancer. Heliyon. 2017;3(6):e00328. DOI:

Drossman DA. Functional gastrointestinal disorders: history, pathophysiology, clinical features, and Rome IV. Gastroenterology. 2016;150(6):1262-79. e2. DOI:

Lovell RM, Ford AC. Global prevalence of and risk factors for irritable bowel syndrome: a meta-analysis. Clinical gastroenterology and hepatology. 2012;10(7):712-21. e4. DOI:

Linedale EC, Andrews JM. Diagnosis and management of irritable bowel syndrome: A guide for the generalist. Medical Journal of Australia. 2017;207(7):309-15. DOI:

Linedale EC, Shahzad MA, Kellie AR, Mikocka-Walus A, Gibson PR, Andrews JM. Referrals to a tertiary hospital: a window into clinical management issues in functional gastrointestinal disorders. JGH Open. 2017;1(3):84-91. DOI:

Masuy I, Pannemans J, Tack J. Irritable bowel syndrome: diagnosis and management. Minerva gastroenterologica e dietologica. 2019. DOI:

Ricciuto A, Griffiths AM. Clinical value of fecal calprotectin. Critical reviews in clinical laboratory sciences. 2019;56(5):307-20. DOI:

An YK, Prince D, Gardiner F, Neeman T, Linedale EC, Andrews JM, et al. Faecal calprotectin testing for identifying patients with organic gastrointestinal disease: systematic review and meta-analysis. Medical Journal of Australia. 2019;211(10):461-7. DOI:

Mari A, Baker FA, Mahamid M, Yacoob A, Sbeit W, Khoury T. Clinical utility of fecal calprotectin: potential applications beyond inflammatory bowel disease for the primary care physician. Annals of gastroenterology. 2019;32(5):425. DOI:

Lamb CA, Kennedy NA, Raine T, Hendy PA, Smith PJ, Limdi JK, et al. British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults. Gut. 2019;68(Suppl 3):s1-s106. DOI:

Chang MH, Chou JW, Chen SM, Tsai MC, Sun YS, Lin CC, et al. Faecal calprotectin as a novel biomarker for differentiating between inflammatory bowel disease and irritable bowel syndrome. Molecular medicine reports. 2014;10(1):522-6. DOI:

Caviglia GP, Pantaleoni S, Touscoz GA, Adriani A, Rosso C, Smedile A, et al. Fecal calprotectin is an effective diagnostic tool that differentiates inflammatory from functional intestinal disorders. Scandinavian journal of gastroenterology. 2014;49(12):1419-24. DOI:

Burri E, Beglinger C. The use of fecal calprotectin as a biomarker in gastrointestinal disease. Expert review of gastroenterology & hepatology. 2014;8(2):197-210. DOI:

Waugh N, Cummins E, Royle P, Kandala NB, Shyangdan D, Arasaradnam R, et al. Faecal calprotectin testing for differentiating amongst inflammatory and non-inflammatory bowel diseases: systematic review and economic evaluation. Health technology assessment (Winchester, England). 2013;17(55):xv-xix, 1-211. DOI:

Gavin DR, Valori RM, Anderson JT, Donnelly MT, Williams JG, Swarbrick ET. The national colonoscopy audit: a nationwide assessment of the quality and safety of colonoscopy in the UK. Gut. 2013;62(2):242-9. DOI:

Walsham NE, Sherwood RA. Fecal calprotectin in inflammatory bowel disease. Clinical and experimental gastroenterology. 2016;9:21-9. DOI:

Carmona-Sánchez R, Icaza-Chávez M, Bielsa-Fernández M, Gómez-Escudero O, Bosques-Padilla F, Coss-Adame E, et al. The Mexican consensus on irritable bowel syndrome. Revista de Gastroenterología de México (English Edition). 2016;81(3):149-67. DOI:

Mearin F, Lacy BE, Chang L, Chey WD, Lembo AJ, Simren M, et al. Bowel disorders. Gastroenterology. 2016.

Lacy B, Patel N. Rome criteria and a diagnostic approach to irritable bowel syndrome. Journal of clinical medicine. 2017;6(11):99. DOI:

Spiegel B, Bolus R, Harris L, Lucak S, Naliboff B, Esrailian E, et al. Measuring IBS patient reported outcomes with an abdominal pain numeric rating scale: results from the proof cohort. Alimentary pharmacology & therapeutics. 2009;30(11-12):1159. DOI:

McFarlane M, Chambers S, Dhaliwal A, Lee B, Sung E, Nwokolo C, et al. Is NICE too optimistic about savings from faecal calprotectin testing? Value in Health. 2015;18(7):A623. DOI:

McLean MH, Murray GI, Stewart KN, Norrie G, Mayer C, Hold GL, et al. The inflammatory microenvironment in colorectal neoplasia. PLoS One. 2011;6(1):e15366. DOI:

Menees SB, Powell C, Kurlander J, Goel A, Chey WD. A meta-analysis of the utility of C-reactive protein, erythrocyte sedimentation rate, fecal calprotectin, and fecal lactoferrin to exclude inflammatory bowel disease in adults with IBS. The American journal of gastroenterology. 2015;110(3):444. DOI:

Lee YW, Lee K-M, Lee JM, Chung YY, Kim DB, Kim YJ, et al. The usefulness of fecal calprotectin in assessing inflammatory bowel disease activity. The Korean journal of internal medicine. 2019;34(1):72. DOI:

Sharbatdaran M, Holaku A, Kashifard M, Bijani A, Firozjahi A, Hosseini A, et al. Fecal calprotectin Level in patients with IBD and noninflammatory disease of colon: a study in Babol, Northern, Iran. Caspian journal of internal medicine. 2018;9(1):60.

Manceau H, Chicha-Cattoir V, Puy H, Peoc’h K. Fecal calprotectin in inflammatory bowel diseases: update and perspectives. Clinical Chemistry and Laboratory Medicine (CCLM). 2017;55(4):474-83. DOI:

Petryszyn P, Staniak A, Wolosianska A, Ekk-Cierniakowski P. Faecal calprotectin as a diagnostic marker of inflammatory bowel disease in patients with gastrointestinal symptoms: meta-analysis. European journal of gastroenterology & hepatology. 2019;31(11):1306-12. DOI:

Sipponen T, Savilahti E, Kolho K-L, Nuutinen H, Turunen U, Färkkilä M. Crohn's disease activity assessed by fecal calprotectin and lactoferrin: correlation with Crohn's disease activity index and endoscopic findings. Inflammatory bowel diseases. 2008;14(1):40-6. DOI:

Von Roon AC, Karamountzos L, Purkayastha S, Reese GE, Darzi AW, Teare JP, et al. Diagnostic precision of fecal calprotectin for inflammatory bowel disease and colorectal malignancy. American Journal of Gastroenterology. 2007;102(4):803-13. DOI:

Van Rheenen PF, Van de Vijver E, Fidler V. Faecal calprotectin for screening of patients with suspected inflammatory bowel disease: diagnostic meta-analysis. Bmj. 2010;341:c3369. DOI:

Freeman K, Willis BH, Fraser H, Taylor-Phillips S, Clarke A. Faecal calprotectin to detect inflammatory bowel disease: a systematic review and exploratory meta-analysis of test accuracy. BMJ open. 2019;9(3):e027428. DOI:

Conroy S, Hale MF, Cross SS, Swallow K, Sidhu RH, Sargur R, et al. Unrestricted faecal calprotectin testing performs poorly in the diagnosis of inflammatory bowel disease in patients in primary care. Journal of clinical pathology. 2018;71(4):316-22. DOI:

Moayyedi P, Andrews CN, MacQueen G, Korownyk C, Marsiglio M, Graff L, et al. Canadian Association of Gastroenterology clinical practice guideline for the management of irritable bowel syndrome (IBS). Journal of the Canadian Association of Gastroenterology. 2019;2(1):6-29. DOI:

Henriksen M, Jahnsen J, Lygren I, Stray N, Sauar J, Vatn MH, et al. C-reactive protein: a predictive factor and marker of inflammation in inflammatory bowel disease. Results from a prospective population-based study. Gut. 2008;57(11):1518-23. DOI:

Fagan EA, Dyck RF, Maton PN, Hodgson HJ, Chadwick VS, Petrie A, et al. Serum levels of C-reactive protein in Crohn's disease and ulcerative colitis. Eur J Clin Invest. 1982;12(4):351-9. DOI:

Poullis AP, Zar S, Sundaram KK, Moodie SJ, Risley P, Theodossi A, et al. A new, highly sensitive assay for C-reactive protein can aid the differentiation of inflammatory bowel disorders from constipation-and diarrhoea-predominant functional bowel disorders. European journal of gastroenterology & hepatology. 2002;14(4):409-12. DOI:

Schoepfer AM, Trummler M, Seeholzer P, Seibold-Schmid B, Seibold F. Discriminating IBD from IBS: comparison of the test performance of fecal markers, blood leukocytes, CRP, and IBD antibodies. Inflammatory bowel diseases. 2008;14(1):32-9. DOI:

Ricanek P, Brackmann S, Perminow G, Lyckander LG, Sponheim J, Holme O, et al. Evaluation of disease activity in IBD at the time of diagnosis by the use of clinical, biochemical, and fecal markers. Scandinavian journal of gastroenterology. 2011;46(9):1081-91. DOI:

Van Limbergen J, Russell RK, Nimmo ER, Ho GT, Arnott ID, Wilson DC, et al. Genetics of the innate immune response in inflammatory bowel disease. Inflammatory bowel diseases. 2007;13(3):338-55. DOI:

Schoepfer AM, Beglinger C, Straumann A, Safroneeva E, Romero Y, Armstrong D, et al. Fecal calprotectin more accurately reflects endoscopic activity of ulcerative colitis than the Lichtiger Index, C-reactive protein, platelets, hemoglobin, and blood leukocytes. Inflammatory bowel diseases. 2013;19(2):332-41. DOI:

Beattie R, Walker-Smith J, Murch S. Indications for investigation of chronic gastrointestinal symptoms. Archives of disease in childhood. 1995;73(4):354-5. DOI:

Loftus EV, Sandborn WJ. Epidemiology of inflammatory bowel disease. Gastroenterology Clinics of North America. 2002;31(1):1-20. DOI:

Taleban S, Colombel JF, Mohler MJ, Fain MJ. Inflammatory bowel disease and the elderly: a review. Journal of Crohn's & colitis. 2015;9(6):507-15. DOI:

Ashktorab H, Panchal H, Shokrani B, Paydar M, Sanderson A, Lee EL, et al. Association between Diverticular Disease and Pre-Neoplastic Colorectal Lesions in an Urban African-American Population. Digestion. 2015;92(2):60-5. DOI:

Peery AF, Barrett PR, Park D, Rogers AJ, Galanko JA, Martin CF, et al. A high-fiber diet does not protect against asymptomatic diverticulosis. Gastroenterology. 2012;142(2):266-72.e1. DOI:

Kostas A, Siakavellas SI, Kosmidis C, Takou A, Nikou J, Maropoulos G, et al. Fecal calprotectin measurement is a marker of short-term clinical outcome and presence of mucosal healing in patients with inflammatory bowel disease. World journal of gastroenterology. 2017;23(41):7387. DOI:

Kwapisz L, Gregor J, Chande N, Yan B, Ponich T, Mosli M. The utility of fecal calprotectin in predicting the need for escalation of therapy in inflammatory bowel disease. Scandinavian journal of gastroenterology. 2017;52(8):846-50. DOI:

Tibble J, Teahon K, Thjodleifsson B, Roseth A, Sigthorsson G, Bridger S, et al. A simple method for assessing intestinal inflammation in Crohn's disease. Gut. 2000;47(4):506-13. DOI:

Naismith GD, Smith LA, Barry SJ, Munro JI, Laird S, Rankin K, et al. A prospective single-centre evaluation of the intra-individual variability of faecal calprotectin in quiescent Crohn's disease. Aliment Pharmacol Ther. 2013;37(6):613-21. DOI:



How to Cite


Similar Articles

1-10 of 153

You may also start an advanced similarity search for this article.

Most read articles by the same author(s)

<< < 1 2 3