From the Guidelines
A calprotectin level of 1260 μg/g indicates significant intestinal inflammation, strongly suggesting active inflammatory bowel disease (IBD) such as Crohn's disease or ulcerative colitis, and requires prompt gastroenterology referral for further evaluation including colonoscopy with biopsies. This level is significantly above the threshold of 150 μg/g, which is commonly used to indicate active inflammation 1. According to the AGA clinical practice guideline, in patients with UC in symptomatic remission but elevated stool or serum markers of inflammation (fecal calprotectin >150 mg/g), the AGA suggests endoscopic assessment of disease activity rather than empiric treatment adjustment 1.
Given the high calprotectin level, initial management may include anti-inflammatory medications like mesalamine (1-4g daily) for mild to moderate ulcerative colitis or corticosteroids such as prednisone (40mg daily with taper over 8-12 weeks) for more severe inflammation. For Crohn's disease, budesonide (9mg daily for 8-12 weeks) may be used for ileal or right-sided colonic disease. Immunomodulators like azathioprine (2-3mg/kg/day) or biologics such as infliximab (5mg/kg IV at weeks 0,2, and 6, then every 8 weeks) might be necessary for moderate to severe disease.
It's also important to consider the patient's symptoms, medical history, and other diagnostic findings when determining the best course of treatment. The European evidence-based consensus for endoscopy in inflammatory bowel disease suggests that repeat endoscopic and histologic assessment is appropriate when diagnosis remains in doubt, and that faecal levels of calprotectin or lactoferrin are emerging as a surrogate marker of mucosal healing and may reduce the need for endoscopic reassessments 1.
Key considerations in management include:
- Prompt gastroenterology referral for further evaluation
- Colonoscopy with biopsies to confirm diagnosis and assess disease severity
- Anti-inflammatory medications or corticosteroids as initial treatment
- Potential use of immunomodulators or biologics for moderate to severe disease
- Dietary modifications and monitoring for complications like anemia or malnutrition
- Consideration of patient symptoms, medical history, and other diagnostic findings in determining treatment.
From the Research
Calprotectin Level of 1260
- A calprotectin level of 1260 is significantly elevated, indicating the presence of intestinal inflammation 2, 3.
- Elevated calprotectin levels are associated with inflammatory bowel disease (IBD), colorectal neoplasia, and gastrointestinal infection 2, 3.
- The specificity of calprotectin for IBD is lower than desirable, as several diseases other than IBD can also increase calprotectin levels 2.
Management of Elevated Calprotectin Levels
- A high concentration of calprotectin in feces is a strong argument to carry out a colonoscopy to rule out the presence of IBD or other organic pathologies 2.
- Calprotectin levels can be used to monitor disease activity in IBD patients, with a decrease in calprotectin concentrations indicating endoscopic healing 2, 4.
- However, there are no clear guidelines on how to manage patients with intermediate levels of calprotectin, and the variability of cut-off values can make interpretation challenging 4.
Clinical Interpretation
- Calprotectin levels are elevated in inflammation and cancer, but are not helpful in differentiating between these disorders 3.
- A cut-off point of 50 μg/g has been suggested for the fecal calprotectin test in pediatric patients with IBD 5.
- Serum calprotectin levels correlate with biochemical and histological markers of disease activity in TNBS colitis, suggesting potential for diagnostic use in patients with IBD 6.