LAUSR

We read with interest the study by Barsky et al. [1] reporting on patient preferences for assessment of disease activity of Inflammatory Bowel Disease (IBD) by either colonoscopy or fecal calprotectin (FC). They report an initial preference for FC. In our IBD center, FC has been routinely used for disease activity assessment for several years. While our patients mostly express a clear preference that for FC when offered choices in clinic, we were concerned about poor sample return rates. There are little published data on patient adherence to FC requests, although a single report from France showed poor return rates in a small sample of patients asked to provide stool samples for repeated and regular calprotectin testing [2]. We examined sample return rates in a large sample of IBD patients cared for in our IBD clinics, infusion unit, and hospital wards in a UK Teaching Hospital. We identified 963 patients (58% female, mean age 41.8 years) who were asked to provide 1277 samples in 2017. In 231 cases (24%), patients were requested to provide a sample on more than one occasion. On a per-patient level, 310 (32%) patients failed to return a sample. Of 1277 requested samples, 753 (59%) were returned with a non-return rate of 41%. FC forms an important part of IBD disease activity assessment by offering an objective measurement of intestinal inflammation. It is cheaper and less invasive than endoscopic assessments, thereby allowing regular routine assessment of mucosal inflammation. The current proposed treatment strategy that recommends a “treat-to-target” approach of complete mucosal healing relies heavily on fecal calprotectin testing [3–5]. Patient adherence to calprotectin sampling would therefore impact heavily on the ability to deliver on a “treat-to-target” approach. We report a nonreturn rate of 41% of requested tests thereby highlighting that at current compliance levels the utility of FC is impaired in routine clinical practice. The current low return rates need to be improved to make treat-to-target policies feasible in clinical practice.