From the Guidelines
Faecal calprotectin is elevated due to various inflammatory conditions affecting the gastrointestinal tract, most commonly inflammatory bowel diseases (IBD) such as Crohn's disease and ulcerative colitis, where calprotectin levels typically exceed 250 μg/g, as supported by the most recent evidence from 1.
Causes of Elevated Faecal Calprotectin
The causes of elevated faecal calprotectin can be broadly categorized into:
- Inflammatory bowel diseases (IBD) such as Crohn's disease and ulcerative colitis
- Infections of the gut, including bacterial, viral, and parasitic infections
- Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, naproxen, and diclofenac
- Colorectal cancer and polyps
- Microscopic colitis, celiac disease, diverticulitis, radiation enteritis, and gastrointestinal bleeding
- Non-GI conditions like obesity, liver cirrhosis, and rheumatoid arthritis
- Age, with slightly higher levels sometimes seen in infants and elderly individuals
Clinical Utility of Faecal Calprotectin
Faecal calprotectin is a useful marker for distinguishing between inflammatory and non-inflammatory conditions of the bowel, helping clinicians determine which patients require further investigation with endoscopy, as noted in 1 and 1.
Interpretation of Faecal Calprotectin Levels
The interpretation of faecal calprotectin levels should be done in the context of clinical symptoms and other diagnostic tests, as recommended in 1 and 1.
Management of Patients with Elevated Faecal Calprotectin
The management of patients with elevated faecal calprotectin should be individualized, taking into account the underlying cause of the elevation, the severity of symptoms, and the results of other diagnostic tests, as suggested in 1, 1, and 1.
From the Research
Causes of Elevated Fecal Calprotectin
Elevated fecal calprotectin levels can be caused by several factors, including:
- Inflammatory bowel disease (IBD), such as Crohn's disease and ulcerative colitis 2, 3, 4, 5
- Colorectal neoplasia 2, 4
- Gastrointestinal infection 2
- Intestinal neoplasms 4
- Subclinical intestinal inflammation in asymptomatic first-degree relatives of patients with IBD 2
Relationship Between Fecal Calprotectin and Disease Activity
Fecal calprotectin levels have been shown to correlate with disease activity in IBD, with higher levels indicating more severe inflammation 3, 4, 5. Additionally, elevated fecal calprotectin levels have been associated with an increased risk of disease relapse in patients with IBD 3, 5, 6.
Non-Invasive Marker of Intestinal Inflammation
Fecal calprotectin is considered a promising non-invasive marker of intestinal inflammation, allowing for the detection of subclinical mucosal inflammation and the prediction of disease relapse 2, 3, 4, 5, 6. Its measurement can be useful in the diagnosis and management of IBD, as well as in monitoring disease activity and response to treatment 3, 5.