What does an elevated fecal calprotectin level of 192 indicate in a patient?

What Does a Fecal Calprotectin of 192 μg/g Mean?

A fecal calprotectin of 192 μg/g indicates active intestinal inflammation and strongly suggests inflammatory bowel disease (IBD), requiring endoscopic evaluation to establish diagnosis and assess disease severity. 1

Clinical Significance of This Level

Your level of 192 μg/g falls into the elevated range (>150 μg/g) that the American Gastroenterological Association identifies as strongly suggesting active inflammatory disease in the gastrointestinal tract. 1

Key interpretation points:

• At levels >150 μg/g with moderate to severe symptoms, there is only a 4.6% false positive rate, meaning 95.4% of patients truly have moderate to severe endoscopic inflammation 1
• This level exceeds the 100 μg/g threshold where specificity improves significantly for detecting endoscopically active disease 1
• While below the 250 μg/g threshold that strongly indicates need for treatment intensification, it still warrants thorough investigation 1

What You Need to Do Next

The appropriate next step depends critically on your symptom severity:

If You Have Moderate to Severe Symptoms

(Frequent diarrhea, significant abdominal pain, rectal bleeding, weight loss)

• Proceed directly to gastroenterology referral for colonoscopy - the combination of symptoms plus calprotectin >150 μg/g reliably indicates moderate to severe inflammation requiring endoscopic assessment 1, 2
• Complete colonoscopy with terminal ileum intubation is preferred over flexible sigmoidoscopy to assess full disease extent 1
• Multiple biopsies should be obtained even from normal-appearing mucosa 1

If You Have Mild or Minimal Symptoms

• Endoscopic assessment is recommended before starting any IBD treatment, as the false positive rate is 15.5% in this intermediate probability scenario 1
• Consider repeat calprotectin testing in 2-4 weeks if symptoms are very mild 2

If You Are Asymptomatic (Known IBD Patient)

• Endoscopic evaluation should be considered, as the false positive rate is 22.4% in asymptomatic patients with known IBD 1

Essential Baseline Testing Before or During Gastroenterology Referral

Complete these tests to assess systemic inflammation and exclude other causes:

• Complete blood count - to assess for anemia and thrombocytosis indicating inflammation 2
• C-reactive protein (CRP) and ESR - complementary inflammatory markers, though 20% of active Crohn's patients may have normal CRP 1, 2
• Comprehensive metabolic panel - to assess for dehydration and electrolyte abnormalities 1, 2
• Stool culture and C. difficile testing - infections can elevate calprotectin and must be excluded 1, 2
• Celiac screen (tissue transglutaminase antibodies) - to exclude celiac disease 2

Important Conditions That Can Cause This Elevation

Calprotectin is not specific for IBD. Other conditions that can elevate levels include:

• Infectious gastroenteritis (must be excluded first) 1, 2
• Colorectal cancer 2, 3
• NSAID use within the past 6 weeks 2
• Microscopic colitis 2
• Hemorrhoids with active bleeding 2

Critical Caveats

If you have alarm features (rectal bleeding with abdominal pain, change in bowel habit, weight loss, or iron-deficiency anemia), you require urgent referral via a suspected cancer pathway regardless of calprotectin level, as calprotectin is not sensitive enough to exclude colorectal cancer. 1, 2

NSAID use is particularly important - if you've taken NSAIDs in the past 6 weeks, repeat testing after cessation is appropriate, as NSAIDs can falsely elevate calprotectin. 2

What Happens at Gastroenterology Evaluation

• Ileocolonoscopy with biopsies is the gold standard for diagnosing IBD, assessing disease extent and severity, and differentiating Crohn's disease from ulcerative colitis 2
• Cross-sectional imaging (MRI or CT enterography) may be needed if Crohn's disease is suspected to assess small bowel involvement and complications such as strictures, fistulas, or abscesses 1, 2

If IBD Is Diagnosed

Serial calprotectin monitoring at 3-6 month intervals can facilitate early recognition and treatment of impending disease flares, with values <50 μg/g generally reassuring and suggesting clinical remission. 1