• Welcome to Crohn's Forum, a support group for people with all forms of IBD. While this community is not a substitute for doctor's advice and we cannot treat or diagnose, we find being able to communicate with others who have IBD is invaluable as we navigate our struggles and celebrate our successes. We invite you to join us.

High CRP and ESR and Negative Calprotectin? Need your Informed Input

J

Jakob

Hello everyone,

I need your input on interpreting the results and on what I should do next.

I just ran the CRP test and ESR test and they came high (CRP: 13.37 mg/L - ESR: 40 first hour and 70 second hour). Yet my Calprotectin results are less than 50 (Negative).

I also have Microcytic hyphochromic red blood cells along with low hematocrit, but everything else in C.B.C (complete blood count) is in normal range(Anemia?).

And I have been having these symptoms:
*Chronic Diarrhea alternating with constipation (sometimes). 4-8 average time I go to the bathroom.
*Bloating, flatulence, and stomach cramps
*Gurgling sound in stomach.
*Constant fatigue
*Brain fog, concentrating is getting harder.
*Joint pain, mostly in my right feet and leg joints.
*Burning pain in anus (occasional), and softness.
*Urge to go to bathroom but nothing when I am there.
*Lately I get easily angered/irritable for no reason.
*Had it before for a while and it went away and then suddenly relapsed.
*Late relapse has been there for more than 5 months now until symptoms became way too much to handle while working.

I am kind of confused by the Calprotectin result being negative and the ESR and CRP being on a really high range ( I am 29 years old). Could this mean I have IBD or should I just stop there based on your own experiences?

I was thinking of maybe getting P-ANCA and ASCA tests to confirm and before that I even wanted to go for a colonoscopy straight but the GP wouldn't agree and said that it moves step by step you just don't jump to a colonoscopy. So what do you all think I should do?

Thank you,

J
 
J

Julia S

My GI's steps when I first went in were to order fecal tests to rule out infections caused by bacteria or other parasites, and a few blood tests to rule out infections that mimic Crohns like histoplasmosis and tuberculosis as well as cytomegalovirus along with tests to make sure I did not have iron, vitamin D, B12 or other deficiencies. After infections were ruled out and due to my high calprotectin (but I think in your case you could repeat the calprotectin test just to make sure), he ordered a CT scan of the small bowel. When that showed thickening of part of the small bowel, he ordered a colonoscopy + endoscopy and, in my case, because the thickened bit was in my mid ileum, he also ordered a single-balloon endoscopy to see further along my ileum. That was all clear, so he ordered a capsule endoscopy that finally revealed inflammation in my small bowel in areas the scope had not reached. That's the order of steps I followed at least. I think its important to first rule out an infection and malignancies before moving on to an IDB diagnosis.

As for P-ANCA and ASCA, only 60% of IBDers have positive values for those so don´t hedge all your bets on those results.

Hope this helped somehow and remember your positive CRP could indicate infection.
 
J

Jakob

Thanks a lot Julia for elaborating, it was really helpful.


Well, I think you have a really good GI. Till now I went to about 4 GIs (Professor Doctors) and they all had different diagnoses and its REALLY frustrating.

The first ordered CRP, Stool analysis and culture, including a digestive system ultrasound and gave me a course of antibacterials (Metronidazole, Cephraloxine, and Anti-Diahreals for a week).

The course made me feel better for a bit, then I had a strong cramps all over my intestine.

The stool analysis and culture came out negative. Though it had few leucocytes and yeast cells.

I did more tests on my own as a form of check-up (Liver function, Thyroid function, Kidney function, Lipids).

All came back normal with the exception of elevated serum uric acid (had some numbing pain in my right foot maybe that's why), and high cholesterol.

My ultrasound showed a distension in my colon and fat on my liver.

The GI told me I had an inflammation in my stomach and intestine based on the above and fat on my liver.

After complaining that from the cramps and the fatigue he told me that it is probably from the fat on the liver (despite the fact that it my liver enzymes are normal). The medicine he gave me was mostly like painkillers for stomach and intestinal issues and the rest was for protecting the liver?! And just urged me to lose some weight and all will be good.

I still had the same symptoms. So I went to another GI.

He told me that the meds I got are useless :D. So wanted to rule out Salmonella Typhi and Brucella. And he used Widal test. I came back positive for Salmonella Typi (o) only in the 1/80 titre (considered normal). He told me that it shouldn't still come as positive and it should be completely negative. So he decided based on that to give an antibiotic course for 21 days (Also the same family of Metronidazole (Quinolines)

The course of antibiotics made me actually feel worse, the crampls were worse and the frequency of visiting the bathroom returned to the way it were again!

I thought something was wrong. So I decided to go to yet another GI. (Keep in mind that these are all professor doctors).

The third GI, mocked the prescriptions of the other GIs and said that they are wrong. And told me that the few yeast cells along with few leucocytes aren't normal in a stool culture. And then took a look at my tongue and noticed a white coating and told me you have a yeast overgrowth.

Took me off all antibacterials and gave me an anti-fungal (Fluconazole) and Nystatin (oral). And told me it is candida.

I was like OKAY doctor. He told to stay on it for 10 days, then do another stool culture and Calprotectin to make sure everything is okay.

I gave his meds a try and it actually made me feel better, the brain fog was gone and I had much less fatigue, yet I had almost the same frequency of going to the bathroom.

I started to feel a constant dull ache just under my chest (the beginning of the stomach) and it wouldn't go away using any meds. Because I still wasn't sure I decided to go to another GI.

This GI actually went about telling me that all my tests are fine. And completely disregarded CRP and ESR because of Calprotectin and thought that all the GIs diagnosis was just wrong, even the last one. And told me to just stop all medication because it is all in my mind and I have IBS and everyone in the world have IBS, and the dull ache because of all the medications the doctors were giving me as it was ruining the stomach flora and thus increasing problems. She urged me to just lose weight and everything is gonna be okay because I am just 29. And just because I am concerned about my health and doing many tests to insure I am alright. It is kind of over-doing it and it is probably all in my mind ( didn't say it directly but implied it well). This really pissed me off like I am imagining my symptoms or something!?

Honestly I have no idea which GI is right.

Many of my friends who worked in Labs told me to run a H-pylori stool antigen test to rule it out. And I decided to run Ferritin test and Occult blood in stool as a final check as to whether there is inflammation or not. And to rule out the diagnosis of fungi, I decided to run a Throat and stool fungal culture.

I honestly don't know if this this the right thing to do, but I hate the fact that doctors just make decisions solely based on assumptions without actual proof many times.

Please let me know if you have further advice. Thanks a lot.
 
A

Alliesavage

Hello Jakob!
First off like the others have said, sometimes our calprotectin can be ok. 2nd hang in there! I have had issues with Crohn's since I was 14. The only signs my body has ever shown were much like yours except I had high white cell count and CT scans showed thickening of bowels and mesenteric lymph node swelling. It took me finding a really good GI doctor who did the scopes and said "My scopes only see a little bit but I know there's something wrong, I'm going to see if the insurance will pay for the pill camera"
Sure enough, I have severe active Crohn's in my small bowel. It's so bad that most pain medication makes me have the most horrible pain. Morphine by IV at the ER caused me so much pain my pulse was 220 before they hit me with Valium. Ask for a CT. Ask for the scopes. Ask for, no demand, the pill camera! They will say you don't have to do prep for the pill camera but do it anyway. Good luck. Keep fighting for your health.

Allie
 
J

Jakob

Yeah totally! The worst is when everyone around you thinks that "maybe" it is just in your head and you are deluding yourself or something to get attention, or your mental state is the cause for all of that, as if someone doesn't have constant highs and lows in their life and you are always miserable thus it is the cause of the constant troubles you are going through. I guess that some doctors are just lazy or arrogant or something.

Currently I developed lactose intolerance for absolutely no reason and I never had that before in my life, in fact I consumed dairy products especially milk like a lot. How can that be IBS? So yeah it is frustrating. So I guess I am gonna just let go until something comes up.
 
A

Alliesavage

Jakob said:
Yeah totally! The worst is when everyone around you thinks that "maybe" it is just in your head and you are deluding yourself or something to get attention, or your mental state is the cause for all of that, as if someone doesn't have constant highs and lows in their life and you are always miserable thus it is the cause of the constant troubles you are going through. I guess that some doctors are just lazy or arrogant or something.

Currently I developed lactose intolerance for absolutely no reason and I never had that before in my life, in fact I consumed dairy products especially milk like a lot. How can that be IBS? So yeah it is frustrating. So I guess I am gonna just let go until something comes up.
Click to expand...
Worse than other people thinking it's in your head you actually get to a point where you start doubting your OWN sanity.
Crohn's is an auto immune disease meaning that things you used to be able to tolerate you may not be able to suddenly. It does make sense. Sadly even if your doctor does believe you it can take time to prove it especially if the tests are unclear. Hang in there and keep a diary of everything. The smallest details matter. Write down everything you put in your mouth everyday. Write down every bowel movement, the consistency of it and how often you're going. Nothing is trivial with IBS.
 
You must log in or register to reply here.
Top