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Fecal Calprotectin

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Fecal Calprotectin

About Fecal Calprotectin
Calprotectin, also known as CALPRO, is a protein found in Neutrophils (Immune Response Cells). Levels of Calprotectin in the stool / feces indicate the presence of these Immune Cells due to damage to the Intestinal Mucosa. Increased fecal Calprotectin levels are observed in patients with Crohn's Disease, Ulcerative Colitis, and other IBD. Fecal Calprotectin is used as one tool to differentiate between pataients with IBD and patients with IBS (Irritable Bowel Syndrome), as IBS patients often have normal levels. Thus, for undiagnosed patients, the Fecal Calprotectin stool test can indicate a diagnosis without more invasive testing methods such as Endoscopy.
Fecal Calprotectin testing may delay IBD diagnosis
One analysis of 13 studies found that the downside of such screening would be a delayed diagnosis in 6% of affected adults and in 8% of affected children because of false-negative test results.[2]
Fecal Calprotectin can Indicate IBD Inflammation and Disease Activity
For patients that are already diagnosed with IBD, monitoring of calprotectin levels can help determine treatment efficacy and whether there has been a relapse or flare. It must be noted that elevated fecal calprotectin levels are associated with other diseases such as cancer, bacterial infection, and NSAID induced mucosal lesions, so it is not used to diagnose IBD alone.[4]

The Sensitivity and Specificity of Fecal Calprotectin for predicting rates of Relapse of Crohn's patients in Remissions are 68% - 100% and 30% - 67%, respectively.[5]

Calprotectin Reference Ranges

Fecal Calprotectin Levels and Patient Age
Reference Ranges for Calprotectin (Age)
Patient AgeUpper limit (mcg/g [ug/g] of feces)
2-9 years166
10-59 years51
> 60 years122
Fecal Calprotectin Levels and Inflammation Severity
Reference Ranges for Calprotectin (Inflammation)
Inflammation Range (mcg/g [ug/g] of feces)
Normal0 - 50
Borderline (Retest 4-6 Weeks)51 - 120
Abnormal> 120

Additional Uses for Measuring Calprotectin

  • Once a baseline Calprotectin levels are determined, levels can be taken after treatments to determine efficacy.
  • Once a baseline Calprotectin levels are determined, levels can be taken to determine if the patient is relapsing or flaring.

Additional Notes

  • Fecal Calprotectin can be Increased in Antibiotic Associated Diarrhea - AAD
  • Fecal Calprotectin can be elevated in Lymphocytic Colitis and Collagenous colitis Colitis in addition to CD and UC.[1]
  • In using Fecal Calprotectin as a diagnostic tool for IBD, false positives may be caused by use of aspirin, NSAIDs, cancer, or liver cirrhosis.[3]

References

[pos]1a[/pos][1] http://www.jiaci.org/issues/vol18issue6/13-22.pdf
[pos]2a[/pos][2] http://www.medscape.com/viewarticle/725672
[pos]3a[/pos][3] http://www.clinchem.org/content/49/6/861.full
[pos]4a[/pos][4] "Advanced Therapy in Crohn's Disease" - Mucosal Healing in IBD: Essential or Cosmetics? - Page 639
[pos]5a[/pos][5]. Yonal O, Kaymakoglu S. How should we follow the Crohn’s disease patients in remission? The Turkish Journal of Gastroenterology. 2010; 21(1): 97-99. http://www.turkgastro.org/pdf/789.pdf

Popular Threads Discussing Fecal Calprotectin



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02-13-2012, 11:17 PM   #1
PVail
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So let me get this right . This test is used to diferentiate between IBS and IBD. Is that based on the level of calprotectin found in the fecies ? it says that Levels of faecal calprotectin are normal in patients with irritable bowel syndrome (IBS).[b so how is that diiferent to IBD. is there a certain level that when it crosses over its IBD or am I missing the point here. If its found in both then then how is it considered the test for IBD ?
Would like to know this if any one know the answer.
02-13-2012, 11:43 PM   #2
momto2teens
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I cannot answer your question. I can tell you that my son was diagnosed CD by colonoscopy. 9 months later all his labs were excellent, but this test was crazy high, so the doc did another scope to check the inflammation compared to the first. Now we are doing Remicade.
I am glad for this test, especially since all of his bloodwork made us think he was great.

Last edited by momto2teens; 02-13-2012 at 11:44 PM. Reason: spelling
02-13-2012, 11:49 PM   #3
PVail
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Thats incredible, Ive had load of tests and I am still undiagnosed even though my condition is getting worse. I was going to mention this test to my GI on my next appointment but I would like to know more about it first so i dont appear stupid. He always says there is not a definitive test for IBD.
02-14-2012, 04:53 AM   #4
Rebecca85
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Faecal calprotectin is found in all stools, it is the 'amount' that can help towards a diagnosis. The tables shows the cut off point - amounts above this are considered abnormal.

I just found a meta-analysis of fecal calprotectin studies. http://www.medscape.com/viewarticle/725672 It is only recently that real work has been put into these tests as a way of diagnosing IBD. The study shows the test has a specificity and sensitivity of over 90% (meaning less than 1 in 10 people with IBD will be 'missed' and less than 1 in 10 positives will be false).

However, at the moment, studies have only concentrated on identifying patients with known IBD from a group (usually they mix IBD and IBS patients and use the test to pick out which is which). The test is not yet available as a diagnostic, because we just don't know how well it will diagnose people. This is because the patient populations are different. (for example, would patients with other inflammatory or autoimmune disorders such as lupus be wrongly identified as having IBD? Can the test distinguish between IBD and infectious colitis?) Also 90% accuracy is fantastic in the lab- but in real life if you were screening 1000s of patients that could mean 100s being misdiagnosed.
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02-14-2012, 03:44 PM   #5
PVail
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Thanks Rebecca

I suppose I was grasping at straws in the hope of something positive.
02-15-2012, 08:41 AM   #6
xX_LittleMissValentine_Xx
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So, if they are not using this test for diagnosis at the moment, then what are they using it for in patients already diagnosed?
Levels of inflammation?
I think my IBD nurse may have mentioned this test to me on the phone recently.
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02-15-2012, 12:16 PM   #7
Rebecca85
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They are studying it as a possible diagnostic test in the future. For it to be useful, they need to get the normal ranges right, decide who gets the test, etc. Otherwise, I could just say 'I know, lets use the colour of your poo as a way of diagnosing IBD'. Unless you know what colour normal people's poo is, and what colour IBD patient's poo is, and that the colours are discernably different, it's useless as a test.

But yes, at the moment it is a useful indicator of inflammation/a flare in IBD patients.
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