Elevated calprotectin level??

What is the actual number?

As IBD patients, it's normal for your baseline to be elevated compared to someone who doesn't have IBD. For example, for me, anything under 200 is perfectly fine and normal, even though anything *over* 100 is concerning for someone who doesn't have IBD. For that reason it isn't super useful in diagnosing pouchitis unless you have a baseline for comparison.

The test does indicate inflammation in the intestines, specifically, where a sed rate and/or C-reactive protein are non-specific blood tests that just show inflammation in the body "somewhere." Of course, if you have active IBD and elevated blood tests, they'll link that.

My daughter's first flare showed a fecal calprotectin of >2000. Off the chart. Normal is <51. She has indeterminate colitis and only showed issue in the large bowel.

What is your actual test #?

I've asked my GI about doing one for me, but he shied away from it. Perhaps because it's not as tested/tracked as in "coloned" people.

I do know that it is very good at showing inflammation in the colon. I read it was a little less perfect at showing small bowel inflammation in coloned people without colon disease.

I can't remember the exact number but it was well over 600. It was explained that it indicates inflammation "somewhere" in the bowel. I guess I'm worried that it might mean pouchitis. My diagnosis has always been UC. I guess another concern is that it could mean a diagnosis of crohns?

I just am not certain it's been well established what the norms are in J pouch patients.

Maybe someone else here has that info?

Liz,

My daughter also has IBD, and her fecal calprotectin is normal right now, on treatment. I don't think that *just* having IBD unequivocally = elevated levels. If you're in remission, it makes sense you would have normal levels. The kids down the street have Crohn's, too, and same has been for them, too. Remission has = normal levels.

Last summer when my pouch was very inflamed, the calprotectin showed over 300. When Augmentin put my pouchitis in remission, it was in the twenties. My G.I. said under a hundred was good. My G.I. explained in layman's terms,that the test measures the (white ? ) blood cells that are passed through the intestine. The more inflammation there is,the more of these cells that pass out of the bowel.

After my pouchscope last year it looked like I just had mild to moderate pouchitis and cuffitis to my GI. He also ran other tests, gross ones, to see how my pouch was looking from the outside in and those tests showed that my entire pouch was inflamed, more than moderate. I have a Large pouch and I forget the proper words but either the top of my pouch is larger than the small intestines it is connected to or the reverse. I'd asked for the tests as I was sure I was having problems with my small intestines. What I didn't know is the area I thought was my small intestines was actually my j-pouch!!! I was relieved to discover it was all contained in my j-pouch. I don't want to lose anymore intestines or have anymore surgeries.

I suspect you need to go back on your antibiotics. My GI says the strength usually prescribed for j-pouchers is a mild compared to what doctors prescribe for infections elsewhere. I compared the strength to what I'd taken for other reasons and it is not as strong. Now I'm not worried about the effects of long term use. I was doing well without them and wham, I've got it back. I'm currently taking flagyl and will alternate it with augmentin. Meaning I take the flagyl for 2 weeks and switch to augmentin for 2.

Good Luck

Rachel, it's a sensitive test but it's not a specific one. IBD patients certainly can have normal calprotectin levels in remission, but an elevated calprotectin in a patient with IBD does not prove active disease.

My son's cal protection went up to 194 and consequently GI wants to make intervals between humira shorter ( we had spaced them out to every 5 weeks.) Once before while on humira he had a calprotectin level of 198 and we switched the antibiotic and ( maintained Humira at 2 weeks which was his dose then) and his cal protection went down. That time he felt sick though and had pouchitis symptoms - this time though he has no symptoms except for the inflammation in cal protectin and slight elevation in CRP (1.2) He has been on rifaximin since last March. Maybe he has a yeast infection? But he does not seem to have pouchitis. So all this to say we have seen inflammation seemed to be caused by pouchitis. But not sure this time what is causing inflammation. Another dr said SIBO would not cause inflammation but it seemed to me SIBO/pouchitis are basically same.

p.s. Plutot - did your dr advocate not treating up to a certain level of inflammation? Thanks.

My kid's GI uses the calprotectin level, if elevated and symptomatic, as a bridge to investigate further.

No "specific" number = changes in treatment without looking at the whole picture, of course. But the test IS specific to the gut. For instance, a patient with only IBS will have a normal level. The test does, if elevated, show *some* sort of gut inflammation. If symptomatic, an elevated level is a bridge to, say, re-scope the patient, perhaps.

Hi everyone thanks for all your replies.

I don't think I have pouchitis because I don't feel as sick as I did when I last had pouchitis. But I don't feel right. And every few weeks I get abdo pain and bloating which can last up to a week. My GI dismissed these symptoms as IBS. Which I've never had since having the jpouch. So I was actually glad when the calprotectin came back elevated because it proved that something was wrong. I did ask about medications but the reply I got was he couldn't treat something without knowing what it was (or words to that effect). So I'm currently waiting for an MRI and than will have an appointment with the GI. I'm just hoping it doesn't get worse.