Fecal calprotectin helps rule out bowel inflammation
In adults aged 50 years or older, a low fecal calprotectin result made inflammatory bowel disease unlikely, but a high result was often a false alarm.
*Retrospective diagnostic accuracy study; Level 3b (OCEBM).

Citation

Perry RW, Foulser PFG, Zhang D, et al. Evaluating the role of faecal calprotectin in older adults: a retrospective observational study. British Journal of General Practice. 2026; DOI: 10.3399/BJGP.2025.0169.

Background

Fecal calprotectin is widely used to detect bowel inflammation, but many guidelines discourage its use in older adults because colorectal cancer becomes more common with age. This study compared test performance in older versus younger adults and also examined stool blood testing when available.

Patients

669 adults (423 aged 18–49; 246 aged 50 or older) who had fecal calprotectin testing followed by colonoscopy; people with known inflammatory bowel disease were excluded.

Intervention

Fecal calprotectin at cutoffs of >50 and >150 micrograms per gram.

Control

Colonoscopy diagnosis; stool blood test (fecal immunochemical test) at cutoff of 10 micrograms per gram when available.

Outcome

Accuracy for inflammatory bowel disease and for “organic” bowel disease (inflammatory bowel disease, colorectal cancer, or other significant findings).

Follow-up Period

From stool test to colonoscopy (median 7–13 weeks).

Results

Comparison Group Key finding
Inflammatory bowel disease vs non-organic findings; fecal calprotectin >50 Age 50 or older Sensitivity 93.8%; negative predictive value 98.9%; positive predictive value 12.8%.
Organic bowel disease vs non-organic findings Age 50 or older Stool blood test outperformed fecal calprotectin at the higher cutoff: negative predictive value 90.6% (stool blood test) vs 85.9% (fecal calprotectin >150).
Among 7 total colorectal cancers, all had fecal calprotectin >50; stool blood tests were positive in all tested cancer cases.

Limitations

Single-center, retrospective design; only patients who underwent colonoscopy; test results may have influenced referral; few colorectal cancer cases.

Funding

None; low risk of sponsor-related bias.

Clinical Application

For adults 50+ with lower bowel symptoms and low cancer suspicion, a low fecal calprotectin (especially with a negative stool blood test) can support avoiding urgent endoscopy.