Fecal Calprotectin results

[kernelmom3]

DD has never had a scope and since it's been about 9 months since her resection her GI wanted to do one. Because DD was perforated during his colonoscopy to diagnosis in 2014 I'm saying no to scopes for right now. We agreed on a fecal calprotectin test. I also had one done for my youngest son because of my oldest both having Crohn's. I got the results yesterday. My youngest had a result of 16.7 which is great and my DD's was 57.6 which the GI said was great for someone with IBD. She did say to keep in mind it's not as good at monitoring the small bowel/terminal ileum but that's where my daughter had her resection. Does that mean she doesn't have a terminal ileum anymore or was a new one "created" when she had the resection? I'm also a bit confused because when the nurse called about my son's results she said the GI (different one/same practice) said it was a pretty "specific" test. All I know is that before surgery DD's FC was 1600! How specific is the test?

 

[Julia S]

Well, there are many markers of inflammation used to evaluate a patient's progress. Many of these markers, however, are not gut specific. CRP, for example, suggests inflammation when raised but it does not mean you have inflammation in the gut. You could have asthma, for example, and your CRP would also be raised. Calprotectin is very specific in that sense: if it is high it means you have intestinal inflammation.

As far as fecal CP not being reliable for ileal disease, that is still up for debate. There are many authors that argue that it is reliable but that you need to be aware that values will be much lower than those seen in colonic disease.

For purely ileal Crohns, for example, it has been suggested that a fecal CP of around 120 already suggest active disease. This same study claims that a CP of below 80 is suggestive of no active disease.

The gold standard for Crohns though is still a scope

 

[my little penguin]

Has she had an Mre and pill cam ?
Honestly there is no replacement for scopes
Fecal caloprotectin sometimes matches the amount of inflammation found on a scope and sometimes it does not
I understand your hesitation
But in monitored disease has a lot of risks as well
Has your gi layed out a list of risks and benefits for you on a scope vs unmonitored disease

 

[Julia S]

A pill cam (if safe for her) could be a good idea. My Crohns is located in a part of my bowel not reachable by scopes so I have pill cams instead. (They are not as good as you cannot biopsy things, but at least its a true picture of what going on in your gut). As long as the doctor doesn't suspect that she might have an obstruction or fistula, it's a safe and easy test.

Another idea is to repeat the calprotectin in 2 weeks or so and see if it is still low. Repeating the calproctin a few times could help ensure that the result she got wasn't a false negative.

 

[kernelmom3]

Thanks everyone! I knew about the CRP and ESR and opted for no labs yet for my youngest because he has asthma and may get an elevated reading from that. DD and DS have both had MRE's but only to check status of fistula and/or abscesses. I know they'll have to have to have scopes eventually, just not looking forward to it. Can anyone tell me more about the pill cam? Do you swallow like any other pill? How long does it take to travel through? Do you see it when it comes out? Do most insurances cover it/is it expensive? Thanks!

 

[Julia S]

The pill cam is about the size of a large vitamin pill. The day before the test you need to prep your bowel. It's a much milder prep than the colonoscopy prep though (usually a liquid diet 24 hours prior to the test and a mild laxative).

You swallow the pill with water just like any other pill and, as it travels down your GI tract, it takes between 2-4 pictures per second depending on the brand/make of the pill. You'll need to wear a belt around your waist for the duration of the exam. The belt holds a little computer that receives the pictures taken by the pill via wifi. You´ll need to fast for a few hours after swallowing the pill to make sure you won´t be photographing food going down your GI tract. The pill has a battery life of between 8-12 hours depending on the make of the pill. After 8-12 hours, therefore, you need to return to the hospital or doctor's office to hand in the computer/belt contraption.

You will pass the pill in the next day or next 2-3 days depending on how quickly things travel through your GI tract. I've done it twice so far and passed the pill the very next morning both times.

It is a pricy test as the pill is expensive to make and you only use it once (of course!). I'm from Brazil so I do not know how easy it is to get insurance approval in the US. In Brazil, at least, insurances will pay for it if the doctor who orders the test justifies its necessity.

Hope this helps!

 

[Clash]

We've only once tried to get a pill cam covered with our insurance. It was at a time the GI was interested in seeing if my son's active disease was located at more than just his ileocecal valve and a bit beyond. The insurance denied it on the premise that he was already diagnosed and didn't need the diagnostic testing a pill cam provides.

We opted for an MRE instead. The GI said if he didn't get the info from the MRE or if the results of the MRE constituted further investigation he felt on appeal the ins would cover the pill cam.

Others have had no trouble getting the pill cam covered after diagnosis so it can be hit or miss. Also, you can always appeal.

In our case, the MRE provided the answers he was looking for so there was no reason to push further for the pill cam.

The terminal ileum is at the end of the small bowel where it connects to the large through the ileocecal valve. The terminal ileum is measured in inches(cm) and the ileum in feet(meters) as far as length. If you Google terminal ileum you can get some great pictorial diagrams.

 

[kernelmom3]

Thanks so much for the info! I'm definitely going to mention it to the GI at her next appointment.

 

[Nbca]

I have a question if your not having any flare up and you feel just fine and you do a calprotectin test will it still show that you have some type of ibd

 

[Clash]

Fecal calprotectin test doesn't test for IBD alone. It is a test that can show if there is inflammation in the bowels. The inflammation could be due to IBD, NSAID over use, infection, cancer etc.

Since it is a type of inflammatory marker if you have no inflammation then your result would be normal.

For instance, in a flare results could be 1200 but if that same person with CD was in remission their result could be 46. The normal reference range varies by lab. NRR at one lab could be <50 while at another it could be <167

 

[Rebeccaadavison]

Calprotectin is not a specific indicator of IBD. If you are in remission, the goal is for a normal reading. So, no to your question. Nor is an abnormal result diagnostic of IBD. It shows intestinal inflammation.

 

[kernelmom3]

We used the FC test as the least invasive way to check our youngest son because he has no symptoms (thank God) and labs might be elevated because he has asthma. Also, it's a good baseline for future reference.

 

[Nbca]

I was just asking because i have ulcerative colitis and now they are testing me for cd