Transforming IBD monitoring with at-home calprotectin testing

Despite ongoing therapeutic advances, inflammatory bowel disease (IBD) continues to pose a significant clinical and logistical challenge for the NHS. Over half a million people in the UK alone live with Crohn’s disease and ulcerative colitis,¹ both of which are chronic conditions that require lifelong monitoring and swift intervention during flare-ups. For many, symptom flares arise unpredictably and often escalate quickly, carrying a heavy toll on quality of life. However, delays in diagnosis and treatment remain common, exacerbated by the limitations of traditional laboratory testing pathways. To address this issue, an innovative multidisciplinary team at University Hospital Southampton (UHS) NHS Foundation Trust has pioneered a digitally integrated, patient-led model using at-home faecal calprotectin testing. Over the course of 12 months, this approach has demonstrated improved disease management, faster decision-making, greater patient engagement and reduced strain on outpatient services.

IBD is marked by episodes of active inflammation in the gastrointestinal tract, often leading to abdominal pain, diarrhoea, fatigue and other debilitating symptoms. These flares are not only disruptive to patients’ lives, they also carry a steep financial burden. Each flare may lead to urgent clinical intervention, diagnostic testing, hospital admission or therapeutic escalation, placing a heavy load on already stretched services and costing the NHS over £10,500 per patient per year.² While long-term biologic therapies have significantly improved disease control,³ patients taking these medications require close monitoring for efficacy and the risk of adverse effects. For instance, gastrointestinal inflammation can be assessed non-invasively by measuring faecal calprotectin, a highly specific and sensitive biomarker secreted by neutrophils during mucosal inflammation and excreted in stool. Importantly, elevated levels of calprotectin can precede clinical symptoms,⁴ offering a valuable window for therapeutic escalation to prevent worsening disease.

Despite its clinical utility, access to rapid calprotectin testing is often limited by the constraints of conventional laboratory processing. Traditionally, patients suspected of having a flare up were required to submit a stool sample for laboratory-based calprotectin analysis. At UHS, this process involved sending kits to patients who would return their faecal samples via second-class post. Once received, samples were processed in the laboratory, with results being turned around in up to four weeks. Unsurprisingly, patient engagement with this system was suboptimal. Around half of all testing kits sent to patients were never returned, often due to the inconvenience of the process or the discomfort around handling and posting stool samples.