From the Guidelines
Elevated calprotectin levels indicate intestinal inflammation and warrant further investigation, with a threshold of 150 μg/g suggesting active inflammation, as supported by the most recent guidelines 1. If your calprotectin level is high, consult with a gastroenterologist for proper evaluation, which typically includes a colonoscopy to determine the underlying cause. Common conditions associated with elevated calprotectin include:
- Inflammatory bowel disease (IBD) like Crohn's disease or ulcerative colitis
- Intestinal infections
- Colorectal cancer
- Use of certain medications like NSAIDs Treatment depends on the specific diagnosis but may include:
- Anti-inflammatory medications such as mesalamine (1-4g daily)
- Corticosteroids like prednisone (40mg daily with taper)
- Immunomodulators such as azathioprine (50-150mg daily) for IBD Calprotectin is a protein released by neutrophils during inflammation, making it a useful biomarker for distinguishing between inflammatory and non-inflammatory intestinal conditions. Normal levels are typically below 50 μg/g of stool, with values between 50-150 μg/g considered borderline, and values above 150 μg/g suggesting active inflammation, as indicated by recent studies 1. Regular monitoring of calprotectin levels can help track treatment effectiveness and disease activity. In patients with CD or UC, a fecal calprotectin <150 mg/g and normal CRP rules out active inflammation, avoiding endoscopic evaluation for assessment of disease activity, as recommended by the AGA clinical practice guidelines 1. However, elevated biomarkers in this setting merit confirmation with endoscopy before treatment adjustment, as suggested by the guidelines 1. It is essential to consider the pretest probability scenario and the certainty of evidence when interpreting fecal calprotectin results, as highlighted by the AGA clinical practice guidelines 1. In summary, elevated calprotectin levels require further investigation, and treatment should be guided by the underlying cause and the most recent clinical guidelines, prioritizing morbidity, mortality, and quality of life as the outcome, as supported by the highest quality studies 1.
From the Research
Elevated Calprotectin Level
- Elevated calprotectin levels are associated with intestinal inflammation, particularly in inflammatory bowel disease (IBD) 2, 3, 4
- Fecal calprotectin is a useful biomarker for distinguishing IBD from irritable bowel syndrome (IBS) and for monitoring intestinal inflammation 2, 3, 4
- High fecal calprotectin concentrations are also found in other diseases with an inflammatory component, such as infectious enteritis or colorectal cancer 3
Clinical Applications
- Fecal calprotectin can be used to predict relapses and detect pouchitis in patients with IBD 2
- It can also be used to determine whether clinical symptoms in patients with known IBD are caused by disease flares or noninflammatory complications/underlying IBS 2
- Fecal calprotectin may be useful in providing objective evidence of response to treatment 2, 5
Diagnostic and Management Considerations
- Fecal calprotectin has excellent negative predictive value in ruling out IBD in undiagnosed, symptomatic patients 2, 3
- It can be used as a surrogate marker for colonoscopy in certain clinical scenarios, such as in patients with moderate-to-severe ulcerative colitis treated with biologics or small-molecule inhibitors 5
- However, interpretation of fecal calprotectin concentrations must always take into account the clinical history and symptoms specific to each patient 3, 4