Fecal Calprotectin - how high before concern?

[Charleigh]

E's Dr. added fecal calprotectin to his lab draws for the first time and it is elevated. Realistically, how high before you are concerned? I assume that even with meds it isn't in a perfect normal range, right?

The lab uses a 0-120 ug/g range.

 

[Clash]

When on meds and in deep stable remission that includes mucosal healing normal numbers are fairly common.

Shortly after dx and commencement of treatment we checked his fc (this was during an asymptomatic flare) the result was 1700.

Then later into treatment he had a normal fc result of 50.

Around the time we were figuring out his joint pain was JSpA and ran independent of CD my son had a scope, MRE and FC done during a two day period. The scope and MRE showed simmering inflammation which lined up with his fc result of 300s. This simmering inflammation is what eventually led to the requirement of a small bowel resection.

He has since had a result of 54. A scope around the same time showed that his bowel looked pristine but biopsies came back with cellular inflammation.

The first 3 were done by Labcorp when their NRR was <50ug/g. The last was lab Corp but they had moved their NRR to <150 ug/g.

 

[Charleigh]

The scope and MRE showed simmering inflammation which lined up with his fc result of 300s. This simmering inflammation is what eventually led to the requirement of a small bowel resection.
.

So 413 might be concerning because of simmering inflammation?

I will say, he was being a bit lazy with getting in enough ensure the few weeks prior to this labwork. We might need to see his numbers again after his next draw to come to any real conclusions.

Thanks

 

[Maya142]

My daughter has had a perfectly normal FC several times. Each kiddo is different but hers has been around 45, 26, 27 the last three times we've checked it. In the past, the highest it has been up to is 480, so not so high. There are kids who easily go up to 1000+.

We use LabCorp, so <50 is meant to be normal.

Our GI said that there are kids with IBD who have FCs that don't seem to go below 200. However, most GIs agree that complete mucosal healing is the goal - which means no inflammation on biopsies and I would imagine, a normal FC.

 

[Maya142]

Wanted to add that when M's went up to 480, her GI added a new medication because she felt that was too high (Imuran). That worked and her FC went back down.

 

[my little penguin]

Same here
Ds has been 17 and below 15 ( lower detectable limit )
And Gi considered he was coming out of a mini flare at 273

Normal range was up to 50

I would expect a longer time off formula to cause an issue
Crohnsinct has it down to days

 

[Clash]

I'm with MLP, for it to reach 400+ I would think it would take more than a couple weeks. But with no baseline before this another FC may bring more answers. It can take some time for the numbers to normalize though. I think the normal testing range at the least is every 3 months.

 

[crohnsinct]

HAHA...yep! After EEN and resuming full food diet it takes about 12 - 16 weeks for my daughter's FC to creep up to over 500. This last time she hit 500on 50% food for 8 weeks. So I would think easing up a little on formula would take a longer time to reflect in FC.

At the time of follow up pristine scopes O was at 150 FC and doc was happy. In fall 450 and he still wasn't too concerned, even though she was having episodes of blood. He said an FC of 450 wouldn't explain the blood. We just increased her mtx by 2.5 mg's for a few months and then her FC came down to 250.

T had scopes that doc considered OK (few small ulcers and red and cobblestoning TI) and her FC was 500...no change to meds.

I think it is highly individual like everything else with this disease. One kid could have an FC of 500 and be a mess and another like T have 500 ad be sort of o.k.. The best thing to do is watch the trend and see how the numbers correlate with symptoms etc. The absolute best thing to do is get an FC at the same time as scopes so you see exactly what that number means for your child.

I think it also depends on the GI and their experience. If they have been burned by high FC's in the past they will be more proactive. Whereas our GI routinely sees FC's over 1000 so a 500 is nothing and he is willing to wait and see. FWIW, T at dx had 1150.

Good Luck!

 

[Catherine]

The trend is more important than the actual number. We added a new medication with a number just over 200 as it was trend was up.

You will need at least to results.