Faecal calprotectin instead of colonoscopy

[Crohn2357]

Hello, I have a problem: I can't drink any colonoscopy prep liquid, I can't even smell it. I did two colonoscopy in the past and my experience was not good. In this year I will need a new colonoscopy to see if there is any inflammation in intestines. I do some research and I find faecal calprotectin test.
http://en.wikipedia.org/wiki/Faecal_calprotectin
Wikipedia link says: Under specific clinical scenario, the test may eliminate the need for invasive colonoscopy.
So, I thought fecal calprotectin can be an eligible way to determine intestine inflammation.

Do you agree with me? What do you think?

 

[nogutsnoglory]

It would not be a good test as a replacement for a colonoscopy or imaging test. While it will be able to show if inflammation is present in the body it's not necessarily specific to crohn's so you don't know where it's coming from. You would fail to know which areas of the bowel are inflamed, scarred or have any degree of ulceration and to what extent.

If you cannot handle colonoscopy prep, there are other preps out there your doctor can try or they can order an MRI for you.

It's mainly used as a test between colonoscopies and imaging to determine if medication is helping.

 

[DustyKat]

I am assuming you have a diagnosis?

If so then faecal calprotectin (FC) can be useful in determining if there is intestinal inflammation present. If the scopes are being used as a way of tracking progress then the usefulness of FC may be limited. If you are flaring and the GI has a good idea of where your disease is at then it may eliminate the need for a scope but if you are not responding to treatment then further investigations over and above FC would likely be required. Also if you are for all intents and purposes stable with no clinical signs of disease activity a FC will not pick up subtle changes that the GI may see visually and it won't pick up if you have changes that are only seen through histopathology (biopsies).

Dusty. xxx

 

[nogutsnoglory]

Dusty my GI told me that FC levels wouldn't differentiate between intestinal or inflammation elsewhere in the body. Is it definitely only a test showing intestinal inflammation? If it is then that's a different story.

 

[Clash]

NGNG here is some info on it:

Calprotectin is a highly-sensitive clinical biomarker for GI-specific inflammation.

source

Calprotectin is a calcium binding protein of neutrophil granulocytes that correlates well with neutrophil infiltration of the intestinal mucosa when measured in faeces. In the last decade, a large body of evidence on the diagnostic value of faecal calprotectin has accumulated and measurement of calprotectin in faeces has been suggested as a surrogate marker of intestinal inflammation. Testing of faecal calprotectin has been highly useful to distinguish organic from functional intestinal disorders in patients with abdominal complaints. Additionally, faecal calprotectin has reliably identified colonic inflammation in patients with suspected IBD. The use of this inexpensive and widely available test in the evaluation and risk stratification in patients with abdominal complaints is likely to increase in the future.

source

Measurement of faecal calprotectin is a biochemical test for intestinal inflammation, including inflammatory bowel disease.

source

Dusty may have some more relevant information as well.

 

[Sophia]

Calprotectin is widely used where I'm from, and they use it as a supplement to other tests, like colonoscopy. So the calprotectin test are cheaper and easier and hence can be done far more often, to get a better picture of the extent of the inflammation/disease over time. It is supposed to be a fairly accurate marker of inflammation, but I'm not sure whether it is accurate for small intestine inflammation, or if it's more reliable when the inflammation is in the colon? And like nogutsnoglory said, it can't give an accurate picture of where the inflammation is, or other complications that you might have. But if you take calprotectin tests and they show a low grade of inflammation/no inflammation, then your doctor could avoid the colonoscopy altogether, I suppose. So it is definitely worth it, and it's easy and no pain!

 

[PsychoJane]

As other said, with a diagnosis, that test is quite useful and may allow to avoid colonoscopy in certain circumstances. Right now, this is what my GI use along with blood test to make sure I'm still in remission. His words pretty much were that if I was having a wrong FC results that it was enough for him to know he needed to put me back on medication.

Just keep in mind that as annoying as they can be, control colonoscopies worth being done to make sure everything in there is ok as far as scarring, polyps, and anomalies like these.

Each tests has it's advantage but I would not personally rely strictly on FC.

 

[DustyKat]

Hey ngng,

Being a faecal test, FC or faecal lactoferrin, are specific to bowel only. When the bowel is inflamed it results in the area being infiltrated with certain white blood cells in attempt to heal the damage being done. As faecal matter passes over the area cells will shed into the faeces. It won't differentiate as to what is causing the inflammation but you will know that it is bowel only and some sort of active inflammatory process is taking place.

It is the serum (blood) markers CRP and ESR that cannot differentiate between inflammation in the bowel or elsewhere in the body. They will pick up markers from the inflamed area but blood being circulatory it means that there is no way you can tell from where they picked them up.

@Crohn2357 - Hence why the test is not suitable if inflammation is not present or changes are early stage that only biopsy will pick up. Also it will not detect the formation of structural changes such a scar tissue that may have formed in an earlier active phase of the disease.

Dusty. xxx

 

[nogutsnoglory]

Thanks guys. It's really helpful to know that its a more accurate marker once diagnosed with IBD. I don't know why my doctor said that to me, unless they confused it with the blood tests. Hmmm.

 

[DustyKat]

I don't know why my doctor said that to me, unless they confused it with the blood tests. Hmmm.

That is what I was thinking but didn't want to say ngng. :eek2: :lol:

 

[AJC - Australia]

i rekon its a great test! If it shows up you have inflammation then you know the crohns is active….if it says no inflammation, you know you are ok (for now)! I have had it twice and both times, yes it costs money, but much less evasive than having to drink the horrid prep and take the day out to go to hospital and all that goes with a colonoscopy.

 

[Essieluv]

I think that a fecal calprotectin can be a great test, and help manage and track disease. However, it can't really take the place of the ever-present colonoscopy because it doesn't not show specifics like a colonoscopy would. There are other ways to prep for a colonoscopy, besides drinking prep. Suppositories, and enemas could be used. I've also heard of people getting NG tubes placed for barium tests when they were too sick to swallow the barium. I don't know, but perhaps that could be an option for your scope prep????? I know none of those sound fun, but if it leads to solid answers and a better treatment plan, it might be worth it.

 

[Crohn2357]

Essieluv- Thank you.