Fecal Calprotectin

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Sophalicious

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Aug 7, 2014
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Does a positive fecal calprotectin test always indicate IBD?
My almost 3year old daughter has suffered with constipation, blood in stool, mouth ulcers and failure to gain weight. She has also had fevers and stomach cramps. Stool sample has also detected occult blood and pus.
Are we right in fearing an ibd diagnosis?
 
By "positive" do you mean elevated? If so, I don't think so. An elevated FC indicates inflammation in the gut which could be caused by IBD, an infection, an autoimmune condition, or even a virus.
 
Hi thanks for the reply. The result only states positive. I questioned if there should be a value at the lab and they responded that it was either positive (over a certain amount) or negative??
 
Hi and welcome,
Do you have a number with that test result?

My girl is five but dx at three and she had most if not all of the same symptoms.
However there are other GI problems that could cause these things.
Do you see a pediatric gi?
 
Sophalicious said:
Hi thanks for the reply. The result only states positive. I questioned if there should be a value at the lab and they responded that it was either positive (over a certain amount) or negative??
Click to expand...

Was the test maybe called fecal lactoferrin?
 
Hi guys thanks for the welcome. We had the test performed at a lab in Abu Dhabi where we are currently living for my husbands work. It just states 'fecal calprotectin-positive'.
I've had a look on the dreaded google and it appears to be the case that it implies IBD.
We are not able to speak to my daughters GI doctor for another few days.
 
I think we might have another member in your area.
Tag Catherine , is your sister and nephew in this area?
It might be nice for you to meet other parents from the area (if we have any).

Does your child have allergies? There's allergic diseases that can mimic Ibd.:hug:
 
There are some things that can cause a false positive. I think using NSAIDs (such as Advil, Motrin) is one. I think certain infections are another.
 
Yes my sister family and her family live in the UAE. I have Facebook messaged her.

Tagging Maree.
 
Hi,

My son Liam had a really bad year 2012/2013 school year. He had constant mouth ulcers, severe stomach pains, reflux and weight loss. His calprotectin test came back very high however all the scopes we're clear.

Last year his health was reasonably good although his weight is still a bit low and we've stopped looking for answers.

We had calprotectin test done in UAE and the lab result was a specific number.

As long as your health insurance level is good UAE has some positives as a place to go through the diagnostic process as waiting times to see specialists and have tests done are generally very short compared to many other places. Waits to see specialists are generally days not weeks and if they decide to book scopes they can generally get these done in a week or two.

Medical care can be patchy in the UAE though as doctors come from a range of different backgrounds (so if you've got any concerns make sure you get 2nd and possibly 3rd opinons). Dubai has two pediatric gastroentrologists, only one of whom I'd be prepared to recommend. I'm afraid I don't no what the situation is with doctors in Abu Dhabi.
 
Welcome to the forum. I'm sure being away from home and family and friends has added to this stress. Your daughter's symptoms sound a lot like my son's when he was dx'd last yr. But, like the others have said, it could be something else. I hope you get great medical care and your daughter gets on the road to feeling well soon. Take care.
 
Morning all! Thanks so much for the responses. We are very lucky that things move fast out here and the GI doctor we are under used to work in a very large hospital in London so I'm hoping we are in good hands. They are eager to do a colonoscopy but we obviously wanted to wait until we had all the blood and stool tests back.
Sophie's three stool samples over the last 6 weeks have shown occult blood/pus cells. We have seen blood four times. The calprotectin has only been tested once which was yesterday and it came back positive. Maybe they will repeat this and I can ask that it be done in a lab that provides a value.
Sophie had reflux as a baby and has always suffered with constipation but no allergies we know of.
It has only really been the last few months that we have noticed an change in her. She has always been very energetic but has definitely slowed down and is very pale. Her blood tests have not shown her to be anaemic however.
She has stomach cramps and mouth ulcers and has not put on weight for nearly a year.
She had a bladder infection a few months ago which was treated with antibiotics and has not been right since. She has vomited a few times in the night. One of which was just bile.
On Saturday she had a day of severe (15 times) bloody diarrhea and then Monday a huge fever (104) which I could not control. We are not allowed to use NSAIDs because of the bleeding and paracetamol would only bring it down one degree. They ended up putting her on iv paracetamol and antibiotics as they could see a lot of inflammation in her mouth/throat. She however never behaved like she had a sore throat and had a healthy appetite as always.
One doctor at the hospital mentioned that if she had ibd it could make an infection worse and that it can also cause problems in the mouth.
Sorry to waffle on. I'm very nervous and was hoping the fecal calprotectin positive could be due to something else. Very positive to hear that could be the case. Maybe it is due to her throat infection? Thank you all so much!
 
I wondering whether you have received the full results of the faecal calprotectin as the results usually take longer. In Australia it takes two weeks.
 
Ours took a week as well to get results but that is the one lab they send out .
Sorry to hear about the fever .
Did they do other stool tests ( infection)?
Hope they can get her in for the colonscopy soon .
That is the good standard and will help get to the bottom of it quickly.
 
Ok so the lab said that they do the fecal calprotectin in house and confirmed it is completed within two hours. Strange. Maybe it is a new thing. Anyhow the gi doctor has stated that Sophie requires an endoscopy which we were hoping to avoid but needs must : (
 
The scope is harder on the parents than the kid.
Good luck
Hope you get quick results and abswers so she can get better.
 
You still need to know the number associated with her results. "Positive" doesn't really give much information. Glad you are having scopes done though. They really aren't as bad as you think.
 
It's so strange that the lab are adamant that they have no value. They just say if it's positive it means it's above the normal or borderline levels! But how above??
We received her culture back which is negative for any kind of bacteria etc.
Unfortunately the doctors/labs aren't filling us with confidence.
Maree would you be prepared to recommend your gi doc in Dubai please?
 
This is a test where you should have a number. We started with an adult GI at our local clinic who did the basic tests including the Calproc.

We then saw two Pediatric Gastoentrologists, we we're very happy with the 2nd one, Dr Shamar who is based in the Mediclinic Dubai Mall. Dr Shamar is an Indian pediatrician but has done further study (and worked) in US & UK. His Pediatric Gastroentrology training was done in the US.

http://www.mediclinic.ae/DoctorDetails.aspx?drid=369
 
That's great thank you so much Maree.
The whole fecal
Calprotectin postive thing seems very strange. Would be a nice thought to think they had done something incorrectly and she doesn't actually have elevated calprotectin!
Thanks again!
 
Will also mention the adult GI had the calproc run twice. He ordered the 2nd one about a week after the first one came back high. He said he wanted to eliminated the possibility of lab error or some sort of passing infection that had caused a temporary elevation.
 
So apparently there are two different kinds of fecal calprotectin tests. One is qualitative which is what we had done. This will only state negative, borderline or positive. The other is called quantitative whereby you are provided a value.
Thought I would put this on here incase anyone else is ever in the same predicament.
 
Hi guys! So after a couple of month of Sophie being on great form after her iv antibiotics we have recently had another bout of blood in stool, huge fever, stomach pain and mouth ulcers.
After her original qualitative positive calprotectin the last three have been absolutely fine with the number around the 30 mark. Her blood tests are all good apart from high monocytes and the bottom of the normal
Range for zinc.
We are currently consulting with Dr Sharma as recommended. He has run some specific blood tests for Ibd. One was for neutrophil antibodies and I believe the other was regarding something to do with Iga levels.
My question is... Can calprotectin come back normal if a child has IBD?
Two pediatric Gi doctors along with Sophie's paediatrician all seem to think she could have IBD but one is very reassured by the recent low calprotectin and wants to wait and see.
The paediatrician and the other GI doc want her to have scopes regardless.
Obviously we want a diagnosis or for IBD to be ruled out but are also worried about her going under General anaesthetic and having the procedure due to any complications.
Any thoughts or experience on the normal calprotectin?
 
Prior to your most recent update I was leaning toward IBD....but with the lower FC numbers I don't know. A 30 would get a raised brow and a Watch and see from our ped gi but with all her other symptoms???

Have her vitamin and mineral levels been checked? It never ceases to amaze me the effect being low in any one thing could have.

You mentioned she is low end of normal with zinc. Low zinc is responsible for a lot.

http://ods.od.nih.gov/factsheets/Zinc-HealthProfessional/

I would also have her b12 and d checked if they haven't been already. Tagging david and dustykat as they are our vitamin experts. I know they told you she isn't anemic...I will let Catherine give yo the anemia 101 lesson as she is our expert. The way I understand it, they need to look at the right studies to get a true picture of whether or not she is anenic.

I am so sorry for all you are going through. I hope they are able to put the pièces of the puzzle together quickly and get her on her way.
 
Thanks very much for your response. Both her B12 and Vitamin d were fine back in august.
Her zinc is 58 so right at the bottom of normal but still normal. It's so strange.
She has had a CBC many times over the past six months as they always think she has an infection when her fever goes up to 105! But her blood count is always fine apart from Monocytes. They can never find any sign of infection with symptoms, exam or blood work.
The calprotectin levels have thrown things away from IBD as obviously it is a very accurate sign.
Another doctor mentioned polyps or an ulcer could possibly account for her symptoms.
We have the ibd bloods outstanding and the most recent full blood count which was taken on Saturday. Maybe they will shed some light. Thanks again.
 
Ok so the hospital have just emailed her recent blood test results and a few things are off. Am I able to attach them here or is it best to list them?
 
Has she been tested for an immune deficiency? I know you mentioned IgA being tested. Make sure they check IgG levels as well. My daughter has normal IgA but low IgG and that has caused a whole host of issues.
 
Hi thanks so much for the response a she had Iga and igg tested in august and they were both fine. Iga was 0.91 and top of normal is 1.
I can't read exactly what the doctor has written on the claim form for the new blood tests but it looks like ANCA and ASIA? Apparently they are specific tests which can point to or from IBD? Have you heard of these?
 
Bright red blood would mean it mostly likely coming from end of the digestive track. Look for any visible causes on her bottom.

CRP being high or very high means there is inflammation some where in the body.

The problem scoping with a low faecel calprotection is that even if there was a GI issue you are likely to get a negative result.

Compare the current result against the previous results. Are any numbers moving up or down over time?

Ferritin, folate, B12, D. What are the actual numbers and the ranges used.

Paging Malgrave for the discussion on immune deficiency.
 
Hi Catherine thanks so much for your reply.
I have never noticed anything wrong on her bottom and two doctors have done a rectal
Exam. Her Ferritin was tested last time back in August and it was fine at 23.21 (6-233). Her B12 was actually high but they said it could be because she didn't fast. It was 1018 (189-883).
She has had CBC's on and off since the beginning of July.
Her WBC is getting higher each time but still normal.
Her RDW is getting lower but only this last time is it out of range at 10.6% (12-15).
Her Platelets are getting higher each time but still normal.
Her Neutrophils are getting higher each time and have always been out of range slightly but this time they are 59.4% (25-50).
Her Lymphocytes are getting lower each time but this time they are 24.9% (50-56).
Her Monocytes are getting higher each time and have always been out of range. This time they are 13% (4.4-8.8).
Her Eosinophils are getting lower each time. This time they are 0.23% (4-7).
This time is definitely the worst bout. They haven't prescribed antibiotics this time as they did the past two times even though they couldn't find symptoms, signs or blood work that signified bacterial infection.
She does actually have a bit of a cough and cold this time could that cause the high CRP?
She has been fully examined and no doctor has mentioned anything regarding her chest or ears etc which I'm sure they would if she had signs of an infection?
She has pretty much had a fever every day for the past two weeks ranging from 37.7-40.7.
 
CRP can be raised by a cold or infection.

Have they tested for sibo ( small intestinal bacterial overgrowth) this sometimes shows with high vitamin B12. Although it more usually results in low B12 and high folate. Symptoms are irritable bowel syndrome, bloating, diarrhea and excruciating pain in the belly.

http://www.biomedcentral.com/1471-230X/12/5

Second, in several important gastrointestinal disorders, such as small bowel bacterial overgrowth, celiac disease, or food lactose intolerance, fecal calprotectin levels will be normal [45,46]
 
Wow Catherine you really know your stuff. Thank you so much for taking the time to get back to me. I can't tell you how much I appreciate it.
She definitely hasn't been tested for SIBO and haven't even heard it mentioned by the docs. I will be sure to ask. Celiac has been bought up a few times but both the GI specialists have said it wouldn't cause blood in the stool which I'm sure I have read it can in the past!
The doctor we saw on Saturday has run a food allergy panel for which we receive the results next week. I assume this will rule out Celiac or lactose intolerance?
Thanks again!
 
We found my daughter's SIBO through scopes. I'm not sure how much it played a part in her symptoms, but it makes sense that someone with an immune deficiency would have an abundance of bacteria. You can ask your GI if this has been checked and maybe you were unaware.
 
Hi Dancemom thanks for your reply.
I thought I read it can only be tested through scopes or breath test? Is there another way?
Thanks again!
 
Sophalicious said:
Hi thanks so much for the response a she had Iga and igg tested in august and they were both fine. Iga was 0.91 and top of normal is 1.
I can't read exactly what the doctor has written on the claim form for the new blood tests but it looks like ANCA and ASIA? Apparently they are specific tests which can point to or from IBD? Have you heard of these?
Click to expand...

@Sophalicious:

The blood test would be ASCA and is normally ordered in conjunction with ANCA.

ASCA testing for Crohn's disease:

The anti-Saccharomyces cerevisiae antibody (ASCA) has over recent years been found to be a useful diagnostic marker for Crohn’s disease.

Important points about ASCA testing:

ASCA testing involves determination of the both the IgA and IgG class antibodies. The test is considered abnormal if either or both IgA and IgG antibodies are positive.

The ASCA test is positive in approximately 60-70% of patients with Crohn’s disease, 10-15% of patients with ulcerative colitis and only 0-5% of healthy control subjects. Therefore, the ASCA is particularly useful in helping to differentiate between these two forms of inflammatory bowel disease. Because a significant minority of Crohn’s disease patients do test negative for ASCA, a negative result does not exclude the diagnosis.

Whilst ASCA appears to be reasonably specific for Crohn’s disease, positive results have also been reported in patients with coeliac disease.

Amongst the Crohn’s disease patient population, those testing positive for ASCA appear to have a poorer prognosis than those testing negative. For example, ASCA-positive patients are more likely to develop complications (eg, internal fistulas, fibrostenosis, perianal disease) or require surgical intervention.

As for many other autoimmune disorders, positivity for ASCA may precede clinical disease manifestations by several years.

In the evaluation of patients with suspected inflammatory bowel disease, testing for ASCA is often combined with testing for ANCA. Patients with Crohn’s disease may exhibit the combination of ASCA-positive but ANCA-negative results, whereas those with ulcerative colitis may exhibit the opposing profile of ASCA-negative but ANCA-positive results. When positive in ulcerative colitis, the ANCA usually exhibits the perinuclear (pANCA) pattern.

When to order the ASCA test:

For patients with features of inflammatory bowel disease, to help differentiate Crohn’s disease from ulcerative colitis (order together with ANCA).

For patients with known Crohn’s disease, to help assess risk for disease complications and likely need for surgery.

http://www.moavenandpartners.com/doctors/information_form/asca-testing-for-crohns-disease.shtml
Click to expand...

Dusty. xxx
 
Thank you so much Dusty! They were the tests and they both came back negative and the specialist has said that this has ruled out IBD by around 80% and along with the recent low calprotectin numbers he is feeling positive. He said we must proceed with the endoscopy an colonoscopy though to be able to confirm and hopefully get to the bottom of Sophie's symptoms. He is leaning more towards Polyps or Solitary Rectal Ulcers.
Thank you all so much for you help and advice.
Nervous times. Part of me is more nervous that they won't get to the bottom of what is wrong for some reason!
 
It would be wonderful if your lass doesn’t have IBD hun. :ghug: And fingers crossed that it is so!

I do hear you though and I hope the scopes provide you with solid answers and whatever they are it is easily treated.

Good Luck and please keep us posted with how Sophie is getting on. :heart:

Dusty. xxx
 
Hey guys so my daughter finally had her scopes a couple of days ago. The doctor came out and said that she had found a small area of irregularity in the small bowel and that this could be inflammation, allergy or even just normal for my daughter. She also said she saw some minor changes. She said we now have to wait for the biopsy results.
Has anyone else received tense kind of findings at endoscopy for their little one or has it always been very obviously ibd?
Thanks x
 
DS visually looked good for his scopes at dx
Gi showed us pretty photos and said it was probably a food intolerance causing the issues.
However biopsies came back with granulomas and acute/chronkc inflammation in his stomach duodenum terminal ileum caecum and rectum consistent with crohns
So it does happen

Good luck
 
Sophalicious said:
Hey guys so my daughter finally had her scopes a couple of days ago. The doctor came out and said that she had found a small area of irregularity in the small bowel and that this could be inflammation, allergy or even just normal for my daughter. She also said she saw some minor changes. She said we now have to wait for the biopsy results.
Has anyone else received tense kind of findings at endoscopy for their little one or has it always been very obviously ibd?
Thanks x
Click to expand...

My daughter's scopes were a lot like that. The pill cam showed more inflammation.
 
My children's scopes came with a very obvious Crohn's diagnosis but they also had elevated labs and disease in a location where the scopes could reach. There are many feet of small bowel that can not be visualized with scopes and you made need further imaging to get the whole picture.

...and yes there are quite a few people here who had visually clear scopes and inflammation was found with biopsies. Not the norm but it does happen.
 
Hi, clear scopes for my babe but the biopsies told a different story.
The second scope had a little more damage but still the biopsies told more of the story.
The doctors and I are working very hard at keeping it microscopic level.
Right now she's been declared in remission.:)
 
My girl's scopes were mostly clear - a lot of redness and friability at her terminal ileum and a few tiny white ulcers in her colon. Biopsies showed inflammation and granulomas and she was diagnosed with Crohn's.
Hang in there!
 
Thanks so much for taking the time to get back to me. I really appreciate it.
We get the biopsy results on Wednesday so will know more then what were dealing with.
Thanks again!
 
Hi Sophalicious,
I was just catching up on the forum and was reading your post. I sent you a private message.
 
So we received the biopsy results and they rule out IBD. The plan from here on is to assume allergy or infection.
As much as we are over the moon and feel very lucky. We have no real answer.
Anyhow I just wanted to conclude this and thank you all for your advice and support.
Very best of luck to all of you xx
 
Yes please keep us updated. If it's allergy, I can recommend a good forum for that. Let me know.:thumright:
 
Thanks guys. I will definitely let you know once we have a resolution. Thankfully Sophie is so well right now so we have time to figure it all out. Thanks again. Take care x
 
Dear Am in abu dhabi and my son has crohn;s in 2014

Dr. NIGEL BEEJAY IS THE BEST GASTRO HERE AND fECAL PROTECTIN DONE IN 2HRS ONLY AND THIS DOCTOR IS AMAZING AM A PHARMACIST AND MY ADVISE TO VISIT HIM

IN Acds , ADVANCED ONE DAY SURGERY MEDICAL CENTER



AL THE BEST
 

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