Other cause for Calprotectin

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Orchidfox
New Member


Date Joined May 2017
Total Posts : 15
   Posted 9/15/2017 4:33 AM (GMT -6)   
Hi so it's me again.

I have question regarding elevated calprotectin. So as I have stated before, I have loose,weird colors (from clay to green poo) and kinda porridge/oatmeal shape stools for over 2 years.

All my scopes came back normal. Twice endoscopy, twice colonoscopy, and a pillcam on March last year and March and May this year. However, my calprotectin levels kept going up from 300ish at earlier this year to 700ish last month. Doc final verdict is I have IBS-D, ignoring the crazy high calprotectin because of all the clear scopes. Still, he prescribe me Salofalk. Which up until now still have those loose stools everyday,like the meds take no effect.

Right now no matter how much I'm in denial and fear for IBD, still thinking probably I have Crohn rather than IBS, with all the symptoms I still have. Many members here said Crohn can showup late long after clear scopes.

So set aside IBD for awhile, just curious are there any other possibilities that can cause FC level that high? Or can be the inflammation located outside GI tract with high FC?

Post Edited (Orchidfox) : 9/15/2017 5:37:43 AM (GMT-6)


iPoop
Forum Moderator


Date Joined Aug 2012
Total Posts : 10527
   Posted 9/15/2017 6:48 AM (GMT -6)   
The fecal calprotectin (FCP) test is known to have false positives and false negatives within certain individuals, and thus for them the test is an unreliable indicator of gastero-intestinal tract inflammation. In that case, a C-Reactive Protein (CRP) blood test would be used instead as an indicator of inflammation levels (given that CRP is body-wide inflammation levels). I would propose that you fit into that outlyer group for whom the FCP test is just inaccurate. Scopes and biopsies don't lie, you've had multiple and no inflammation was shown.

Here's a couple articles on false positives and false negatives, and odds thereof.

clinchem.aaccjnls.org/content/49/6/861

/www.ncbi.nlm.nih.gov/pubmed/12765980

Abstract
BACKGROUND:
Fecal calprotectin (FC) has been proposed as a marker of inflammatory bowel disease (IBD), but few studies have evaluated its usefulness in patients with chronic diarrhea of various causes. We evaluated the diagnostic accuracy of a FC assay in identifying "organic" causes of chronic diarrhea in consecutive adults and children.

RESULTS:
In adult patients, FC showed 64% sensitivity and 80% specificity with 70% positive and 74% negative predictive values for organic causes. False-positive results (8 of 40 cases) were associated with the use of aspirin (3 cases) or nonsteroidal antiinflammatory drugs (1 case) and with the presence of concomitant liver cirrhosis (3 cases). False-negative results mainly included patients suffering from celiac disease (5 cases). Patients with IBD (9 cases) were identified with 100% sensitivity and 95% specificity. In pediatric patients, sensitivity was 70%, specificity was 93%, and positive and negative predictive values were 96% and 56%. False-negative results (11 of 35 cases) were associated mainly with celiac disease (6 cases) or intestinal giardiasis (2 cases).

CONCLUSIONS:
FC assay is an accurate marker of IBD in both children and adult patients. In adults, false negatives occur (e.g., in celiac disease) and false-positive results are seen in cirrhosis or users of nonsteroidal antiinflammatory drugs. Diagnostic accuracy is higher in children.
Moderator Ulcerative Colitis
John
, 39, UC Proctosigmoiditis
Rx: Remicade @5mgs/kg/6wks; daily 75mgs 6MP, 4.8g generic-Lialda, and rowasa

Must've been a barking-spider!

NiceCupOfTea
Veteran Member


Date Joined Jan 2010
Total Posts : 9921
   Posted 9/15/2017 8:48 AM (GMT -6)   
Do you take NSAIDs (e.g. ibuprofen) or PPIs (e.g. omezaprole) regularly? Both types of meds have been linked to an increased calprotectin.

I presume you've had full sets of blood tests done? And stool tests to rule out any pathogenic/infectious causes of diarrhoea? Has coeliac disease (pillcam should have picked up on that though), cirrhosis and food allergies all been ruled out as possible causes?

If the answer to the first question is no and yes to everything else, then I'm frankly baffled. Whatever else your doctor has done, he hasn't fobbed you off. He's done lots of tests and tried mesalazine (Salofalk) on an experimental basis. But perhaps Pentasa would have been a better choice as that targets the small bowel, which Salofalk doesn't. Could switch to Pentasa and see if that's any better.
Dx Crohn's in June 2000. (Yay skull)
Tried: 5-ASAs, azathioprine, 6MP, Remicade, methotrexate, Humira, diets.
1st surgery 20/2/13 - subtotal colectomy with end ileostomy.
2nd surgery 10/7/15 - ileorectal anastomosis. Stoma reversed and ileum connected to the rectum.
Current status: Chronic flare. Do I have any other kind?
Current meds: 50mg 6MP; Entyvio (started 3/11/16)

Orchidfox
New Member


Date Joined May 2017
Total Posts : 15
   Posted 9/30/2017 5:04 PM (GMT -6)   
Hi, thank you so much for all your reply.

Because I still have loose-porridge like-weird color-stools constantly for the last 3 months, my GI done the FC again for the fourth time, and came back with whooping 2000-ish result, raised 3 times higher in one month from the last which is 700ish. I don't know how to react anymore.

I have cried a lot in fear of IBD especially Crohn, then I became numb after the FC shows no sign of decreasing but keeps increasing. Then my GI only raised the dose of Salofalk from the lowest dose to 3000mg a day. Which still do nothing and I'm still having loose stools, increasing gas and abnormal gurgling/peristalsis especially on my right side starting under the ribs. Still have to take the meds for another 2 weeks then test FC again. Doctor wants to see if the meds affect the FC or no.

Other meds I take is 40mg of ppi called pantoprazole here, as I seems to develop symptoms of heartburn too. Been on and off from it for 2 years too, but I can take it up until 5 times or more in a month.

eleanor_rigby
Regular Member


Date Joined Sep 2016
Total Posts : 32
   Posted 10/1/2017 9:17 AM (GMT -6)   
My doctor said you may get the odd false F.C. but not multiple. 2000 is too high to just be explained by IBS. I can only assume during the tests the problem is getting missed. It’s perhaps too high up in your GI tract for a colonoscopy and the pill cam missed it? I don’t know :-( there is inflammation somewhere though.
28 year old diagnosed with Crohn's disease in the ileum and duodenum
Symptoms since 2006

Bowel resection following perforation of ileum and abscess in 2011

Currently taking: 75mg azathioprine
Status: 3 ulcers at ileum and 1 at duodenum - improvement to colonoscopy 1 year ago
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