From the Guidelines
Elevated calprotectin feces is clinically significant as it is associated with a 4.4 times higher risk of disease relapse in patients with ulcerative colitis (UC) in symptomatic remission, with an estimated annual risk of relapse of 64% in patients with quiescent UC and elevated fecal calprotectin 1. The clinical significance of elevated calprotectin feces can be understood by its role as a biomarker of inflammation in the management of UC.
- Fecal calprotectin is the preferred biomarker used for monitoring, with levels above 150 mg/g considered elevated and associated with a higher risk of disease relapse.
- A study found that patients with elevated fecal calprotectin were more likely to have disease relapse compared to those with normal fecal calprotectin, with a median follow-up of 1 year 1.
- The use of fecal calprotectin as a biomarker can inform prognosis and long-term management in patients with UC, particularly in those with elevated levels.
- It is essential to note that elevated calprotectin levels can be associated with various conditions beyond UC, including infections, colorectal cancer, NSAID use, and celiac disease.
- Serial measurements of fecal calprotectin can track disease progression or improvement, making it a valuable tool in the management of UC.
- The high sensitivity of the test makes it an excellent screening tool to avoid unnecessary invasive procedures in patients with functional gastrointestinal disorders, although specificity is lower due to the multiple potential causes of elevation.
From the Research
Clinical Significance of Elevated Calprotectin Feces
Elevated calprotectin feces is a significant indicator of intestinal inflammation, which can be associated with various gastrointestinal diseases. The following points highlight the clinical significance of elevated calprotectin feces:
- Elevated fecal calprotectin levels are a useful predictor of the need for escalation of therapy in patients with established inflammatory bowel disease (IBD) 2.
- Fecal calprotectin is an effective tool for initial screening and monitoring response to therapy in IBD patients 2, 3.
- Elevated fecal calprotectin levels in patients with IBD are associated with an increased risk of disease relapse within 12 months of follow-up 3.
- Fecal calprotectin can detect subclinical mucosal inflammation, which can help identify patients at risk for relapse 3.
- Elevated fecal calprotectin levels can also be found in other diseases with an inflammatory component, such as infectious enteritis or colorectal cancer 4.
- In patients with a normal colonoscopy, an elevated fecal calprotectin level may indicate upper GI disease, but it is not associated with an increased risk of significant GI disease during a follow-up period of 3 years 5.
Diagnostic and Management Implications
The measurement of fecal calprotectin has several implications for the diagnosis and management of IBD and other gastrointestinal diseases:
- Fecal calprotectin testing can help distinguish between functional disorders, such as irritable bowel syndrome, and organic disorders, such as IBD 6.
- Elevated fecal calprotectin levels can indicate the need for additional examinations, such as colonoscopy, to diagnose IBD 4.
- Fecal calprotectin can be used to monitor intestinal inflammation and evaluate therapeutic responses, providing evidence of relapse or mucosal healing 3, 4.
- The interpretation of fecal calprotectin concentrations must always take into account the clinical history and symptoms specific to each patient 4.