High prevalence of NSAID enteropathy as shown by a simple faecal test

Background-The diagnosis of nonsteroidal anti-inflammatory drug (NSAID) ind uced enteropathy is difficult, requiring enteroscopy or the use of four day faecal excretion of In-111 labelled white cells. Aims-To assess faecal calprotectin (a non-degraded neutrophil cytosolic pro tein) as a method for diagnosing NSAID enteropathy. Methods-Single stool faecal calprotectin concentrations were compared with the four day faecal excretion of In-111 labelled white cells in 47 patients taking NSAIDs. The prevalence and severity of NSAID enteropathy was assess ed using this method in 312 patients (192 with rheumatoid arthritis, 65 wit h osteoarthritis, 55 with other conditions) taking 18 different NSAIDs. Results-The four day faecal excretion of In-111 white cells correlated sign ificantly with faecal calprotectin concentrations. In the group of 312 pati ents on NSAIDs faecal calprotectin concentrations were significantly higher than in controls, the prevalence of NSAID enteropathy being 44%. The preva lence and severity of NSAID enteropathy was independent of the particular t ype or dose of NSAID being taken or other patient variables. Conclusions-Assay of faecal calprotectin provides a simple practical method for diagnosing NSAID enteropathy in man. Forty four per cent of patients r eceiving these drugs had NSAID induced enteropathy when assessed by this te chnique; 20% of these had comparable levels of inflammation to that previou sly reported in patients with inflammatory bowel disease.