Calprotectin

Hormone/ Element

Report in 48Hrs

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No Fasting Required

Details

Calprotectin is a calcium- and zinc-binding protein released by white blood cells (neutrophils) during intestinal inflammation.

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Calprotectin Test Information Guide

Why is it done?
- Test Measurement: Calprotectin is a protein found in white blood cells (neutrophils) that is released during intestinal inflammation. The fecal calprotectin test measures the concentration of this protein in stool samples to detect and assess gastrointestinal inflammation.
- Primary Indications: Differentiating inflammatory bowel disease (IBD) from irritable bowel syndrome (IBS); monitoring disease activity in Crohn's disease and ulcerative colitis; evaluating persistent diarrhea and abdominal symptoms; screening for mucosal inflammation; assessing response to therapy in IBD patients.
- Typical Timing and Circumstances: Performed during initial evaluation of gastrointestinal symptoms; when clinical suspicion for IBD exists; at regular intervals to monitor disease progression; before and after treatment initiation to assess therapeutic efficacy; when patients report symptom flares or exacerbations.
Normal Range
- Reference Values: Normal (healthy individuals): < 50 μg/g (micrograms per gram of stool); values may vary slightly based on laboratory reference standards, typically ranging from < 50 to < 100 μg/g depending on the assay method used.
- Units of Measurement: Micrograms per gram of stool (μg/g); some laboratories may report in milligrams per kilogram (mg/kg) or micrograms per milliliter (μg/mL).
- Interpretation Guide: Negative/Normal (< 50 μg/g): Indicates absence of intestinal inflammation, supports diagnosis of IBS or non-inflammatory gastrointestinal conditions; Borderline (50-150 μg/g): Suggests mild inflammation, warrants clinical correlation and possible repeat testing; Positive/Elevated (> 150 μg/g): Indicates significant intestinal inflammation consistent with IBD or other inflammatory conditions; Very High (> 500 μg/g): Suggests severe active inflammation requiring immediate medical attention.
- Clinical Significance: Normal results effectively rule out active IBD with high negative predictive value; elevated results support presence of intestinal inflammation but are not disease-specific; trending values over time provide information about disease activity and treatment response.
Interpretation
- Result Interpretation by Value Range: < 50 μg/g (Normal): No significant intestinal inflammation detected; IBS diagnosis is supported; organic IBD is unlikely; inflammatory etiologies can be excluded; recommend reassessment if symptoms persist; 50-150 μg/g (Borderline): Mild inflammation present; requires clinical correlation with symptoms; repeat testing recommended; follow-up colonoscopy may be warranted; consider other causes of mild inflammation; 150-250 μg/g (Mildly Elevated): Consistent with active mild to moderate IBD; colonoscopy indicated for definitive diagnosis; suggests treatment adjustment may be needed; monitor closely with serial testing; > 250 μg/g (Moderately to Severely Elevated): Indicates active IBD with significant mucosal inflammation; immediate gastroenterology consultation recommended; treatment escalation likely necessary; close monitoring and possibly hospitalization may be required for very high values.
- Clinical Conditions Indicated: Elevated values indicate: Active Crohn's disease; Active ulcerative colitis; Infectious colitis; Gastrointestinal malignancy; Celiac disease; Food sensitivities; Medication-induced colitis (NSAIDs); Microscopic colitis; Diverticulitis; Ischemic colitis.
- Factors Affecting Results: Age (values may differ in pediatric populations); Disease severity and activity; Current medication use (antibiotics, anti-inflammatory agents); Recent infections; Time since symptom onset; Sampling technique and stool consistency; Laboratory methodology used; Presence of concurrent systemic inflammation; Recent bowel preparation or colonoscopy.
- Clinical Significance and Implications: High sensitivity (95-100%) for detecting intestinal inflammation; Lower specificity (85-90%) as elevation occurs in multiple conditions; Excellent negative predictive value for excluding IBD when normal; Useful for monitoring disease remission in IBD patients; Helps predict risk of IBD relapse; Can guide treatment escalation decisions; Serial measurements more informative than single values; May be used to assess need for endoscopic follow-up; Trending over time indicates treatment efficacy.
Associated Organs
- Primary Organ Systems: Gastrointestinal tract (primary focus); specifically the colon, small intestine, and rectal regions; Immune system (detects white blood cell activation); Intestinal mucosa and submucosa; Associated lymphoid tissue.
- Associated Diseases and Conditions: Crohn's disease; Ulcerative colitis; Irritable bowel syndrome (may show mildly elevated values); Infectious gastroenteritis (bacterial, viral, parasitic); Celiac disease; Small intestinal bacterial overgrowth (SIBO); Food intolerances and allergies; Diverticular disease; Colonic polyps and malignancy; Intestinal lymphoma; Whipple's disease; Behçet's disease; Appendicitis; Mesenteric ischemia; Adenomatous polyps; Colorectal cancer; Microscopic and lymphocytic colitis; Medication-induced colitis.
- Diagnostic Assistance: Helps differentiate IBD from IBS with high accuracy; Identifies need for endoscopic evaluation; Screens for organic disease in symptomatic patients; Aids in celiac disease evaluation; Distinguishes inflammatory from non-inflammatory diarrhea; Supports diagnosis of infectious colitis; Identifies subgroups requiring colonoscopy.
- Potential Complications with Abnormal Results: Intestinal perforation if not treated appropriately; Severe gastrointestinal bleeding; Toxic megacolon in severe IBD; Fistula formation in Crohn's disease; Stricture formation causing bowel obstruction; Malnutrition and malabsorption; Increased risk of colorectal cancer with long-standing inflammation; Systemic complications (arthritis, erythema nodosum, pyoderma gangrenosum); Sepsis from perforation or severe infection; Increased susceptibility to opportunistic infections if immunosuppressive therapy initiated.
Follow-up Tests
- Recommended Based on Elevated Results: Colonoscopy with biopsy (gold standard for IBD diagnosis); Flexible sigmoidoscopy for distal inflammation assessment; CT enterography or MR enterography for small bowel evaluation; Upper endoscopy (EGD) if proximal GI involvement suspected; Stool culture and sensitivity for infectious workup; Complete blood count (CBC) for anemia assessment; Comprehensive metabolic panel for nutritional status; Serologic testing for IBD (pANCA and ASCA antibodies); Tissue transglutaminase (tTG) testing for celiac disease; C-reactive protein (CRP) for systemic inflammation.
- Further Investigations: Fecal lactoferrin testing for inflammatory confirmation; Stool ova and parasite examination if infection suspected; Hydrogen breath testing for SIBO; Vitamin and mineral level assessments (B12, folate, iron); Albumin and prealbumin for nutritional evaluation; Prothrombin time (PT) for hepatic or nutritional status; Immunoglobulin levels if immunodeficiency considered; Inflammatory markers (ESR, CRP); Allergy testing if food sensitivity suspected; Repeat calprotectin at 4-8 weeks for therapeutic monitoring.
- Monitoring Frequency: Initial diagnosis phase: Baseline test followed by colonoscopy; Active disease: Every 4-8 weeks during treatment adjustments; Remission monitoring: Every 3-6 months to assess disease control; Post-treatment: At 6-8 weeks after medication initiation to evaluate response; Relapse surveillance: As clinically indicated or with symptom recurrence; Long-term follow-up: Annually in stable remission; More frequent testing if values trending upward or clinical deterioration.
- Complementary Tests Providing Additional Information: Fecal lactoferrin: Confirms neutrophil presence; Fecal occult blood: Detects gastrointestinal bleeding; Endoscopic biopsies: Provides histologic confirmation; Imaging (CT, MRI): Assesses distribution and extent of disease; Serologic markers (ASCA, pANCA): Helps classify IBD subtype; Inflammatory markers (CRP, ESR): Reflects systemic inflammation; Colonoscopic ultrasound: Evaluates strictures and fistulas; Capsule endoscopy: Visualizes small bowel mucosa.
Fasting Required?
- Fasting Requirement: No fasting required - This is a non-invasive stool test that does not require fasting or dietary restrictions prior to collection.
- Patient Preparation and Collection Instructions: Collect stool sample into sterile, labeled container provided by laboratory; Can be collected at home in morning without special timing; No bowel preparation needed unless concurrent colonoscopy planned; Use clean collection techniques; Avoid contamination with urine or toilet water; Refrigerate sample if not delivered immediately to laboratory; Transport to lab within 24 hours; Can be shipped via mail in suitable containers if necessary.
- Medications to Avoid or Report: No medications need to be discontinued for this test; Report current medications to physician as they may influence interpretation (especially anti-inflammatory drugs, antibiotics); Some medications may affect result reliability: Bismuth subsalicylate and laxatives should ideally be avoided 2-3 days prior; Recent antibiotic use should be documented; NSAIDs and corticosteroids should be documented; Proton pump inhibitors and H2 blockers can be continued without affecting test.
- Additional Preparation Requirements: No special dietary restrictions required; Can eat and drink normally before collection; No fasting period necessary; Maintain normal hydration; Continue regular medications unless specifically instructed otherwise; Avoid laxatives, stool softeners, or enemas for 2-3 days if possible; Do not use mineral oil or antacids containing bismuth immediately prior; If colonoscopy planned simultaneously, follow colonoscopy prep instructions instead; Ensure sample is collected during typical bowel movement, not forced; Multiple samples on consecutive days may improve sensitivity if requested by physician.

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