Calprotectin

At a Glance

Why Get Tested?

To detect inflammation in the intestines; to distinguish between inflammatory bowel disease (IBD) and non-inflammatory bowel conditions; to monitor IBD activity

When To Get Tested?

When you have bloody or watery diarrhea, abdominal cramps, with or without fever, lasting more than a few days

Sample Required?

A stool sample is collected in a clean container provided by the laboratory. This sample should be uncontaminated by urine or water.

Test Preparation Needed?

None

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Looking For Reference Ranges?

You may be able to find your test results on your laboratory’s website or patient portal. However, you are currently at Lab Tests Online. You may have been directed here by your lab’s website in order to provide you with background information about the test(s) you had performed. You will need to return to your lab’s website or portal, or contact your healthcare practitioner in order to obtain your test results.

Lab Tests Online is an award-winning patient education website offering information on laboratory tests. The content on the site, which has been reviewed by laboratory scientists and other medical professionals, provides general explanations of what results might mean for each test listed on the site, such as what a high or low value might suggest to your healthcare practitioner about your health or medical condition.

The reference ranges for your tests can be found on your laboratory report. They are typically found to the right of your results.

If you do not have your lab report, consult your healthcare provider or the laboratory that performed the test(s) to obtain the reference range.

Laboratory test results are not meaningful by themselves. Their meaning comes from comparison to reference ranges. Reference ranges are the values expected for a healthy person. They are sometimes called “normal” values. By comparing your test results with reference values, you and your healthcare provider can see if any of your test results fall outside the range of expected values. Values that are outside expected ranges can provide clues to help identify possible conditions or diseases.

While accuracy of laboratory testing has significantly evolved over the past few decades, some lab-to-lab variability can occur due to differences in testing equipment, chemical reagents, and techniques. This is a reason why so few reference ranges are provided on this site. It is important to know that you must use the range supplied by the laboratory that performed your test to evaluate whether your results are “within normal limits.”

For more information, please read the article Reference Ranges and What They Mean.

What is being tested?

Calprotectin is a protein released by a type of white blood cell called a neutrophil. When there is inflammation in the gastrointestinal (GI) tract, neutrophils move to the area and release calprotectin, resulting in an increased level in the stool. This test measures the level of calprotectin in stool as a way to detect inflammation in the intestines.

Intestinal inflammation is associated with inflammatory bowel disease (IBD) and with some bacterial GI infections, but it is not associated with many other disorders that affect bowel function and cause similar symptoms. Calprotectin can be used to help distinguish between inflammatory and non-inflammatory conditions.

IBD is a group of chronic disorders characterized by inflamed and damaged tissues in the lining of the intestinal tract. The cause of IBD is not known, but these diseases are thought to be due to an autoimmune process that has been triggered by a genetic predisposition, a viral illness, and/or an environmental factor. The most common inflammatory bowel diseases are Crohn disease (CD) and ulcerative colitis (UC).

People with IBD typically have flare-ups of active disease that alternate with periods of remission. During a flare-up, a person may experience frequent bouts of watery and/or bloody diarrhea, abdominal pain, weight loss, and fever. Between these flare-ups, symptoms frequently subside. Many people may go through extended periods of remission between flare-ups. Calprotectin testing can be useful in monitoring disease activity. The test is not specific or diagnostic for IBD, but it may be done to detect and evaluate the degree of inflammation.

Common Questions

How is it used?

Calprotectin is a stool (fecal) test that is used to detect inflammation in the intestines. Intestinal inflammation is associated with, for example, some bacterial infections and, in people with inflammatory bowel disease (IBD), it is associated with disease activity and severity. The calprotectin test is not diagnostic but may be used to distinguish between IBD and non-inflammatory disorders and to monitor the severity of IBD.

A healthcare practitioner may order a calprotectin test to help investigate the cause of a person’s persistent watery or bloody diarrhea. The test may be ordered along with other stool tests, such as a stool culture to detect a bacterial infection, a test for ova and parasites (O&P), a stool white blood cell test, and/or a fecal occult blood test (FOBT). If a healthcare practitioner suspects inflammation, then a blood test that detects inflammation in the body, such as a C-reactive protein (CRP), or an erythrocyte sedimentation rate (ESR) if CRP is not available, may also be ordered. Testing is performed both to help determine what is causing a person’s symptoms and to rule out conditions with similar symptoms. This means that additional blood and stool testing may be performed depending on the suspected causes.

A calprotectin test may be ordered to help determine whether an endoscopy is indicated if IBD is suspected. A diagnosis of IBD is usually confirmed by performing an endoscopy (colonoscopy or sigmoidoscopy) to examine the intestines and by obtaining a small tissue sample (biopsy) to evaluate for inflammation and changes in tissue structures. This testing is invasive and is less likely to be necessary if inflammation is not present.

A calprotectin test may be ordered if a person with IBD has symptoms that suggest a flare-up, both to detect disease activity and to help evaluate its severity. For example, if a person has a moderately elevated calprotectin, then testing may be repeated several weeks later to see if it has stayed moderately elevated, increased, or returned to normal.

When is it ordered?

A calprotectin test may be ordered when a person has symptoms that suggest inflammation of the digestive system and when a healthcare practitioner wants to distinguish between IBD and a non-inflammatory bowel condition.

Signs and symptoms of IBD will vary from person to person and over time. They may include one or more of the following:

Bloody or watery diarrhea
Abdominal cramps or pain
Fever
Weight loss
Rectal bleeding
Weakness

Testing for calprotectin may be performed when a healthcare practitioner wants to determine whether an endoscopy (colonoscopy or sigmoidoscopy) is likely or less likely to be necessary.

When a person has been diagnosed with IBD, a calprotectin test may be ordered whenever a flare-up is suspected, both to confirm disease activity and to evaluate its severity.

What does the test result mean?

An elevated calprotectin level is a person’s stool indicates that inflammation is likely present in the intestines but does not indicate either its location or cause. In general, the degree of elevation is associated with the severity of the inflammation.

Increases in calprotectin are seen with IBD, but also with bacterial infections, some parasitic infections, and with colorectal cancer. An endoscopy (colonoscopy or sigmoidoscopy) may be indicated as a follow-up test to help determine the cause of inflammation, signs, and symptoms.

In people newly diagnosed with IBD, concentrations of calprotectin may be very high.

A low calprotectin means that signs and symptoms are likely due to a non-inflammatory bowel disorder. Examples of these include viral infections in the digestive tract and irritable bowel syndrome (IBS). Unlike IBD, IBS does not cause inflammation. Rather, it causes cramp-like stomach pains and spasms with bouts of diarrhea and/or constipation. In people with low calprotectin results, an endoscopy is less likely to be indicated or useful.

A moderate calprotectin level may indicate that there is some inflammation present or that a person’s condition is worsening. A repeated calprotectin test with a result that is still moderately elevated or that has increased is likely to require further investigation and may warrant an endoscopy.

Is there anything else I should know?

Anything that causes inflammation in the intestines can cause an increase in stool calprotectin.

Calprotectin can be increased with the intestinal tissue damage and bleeding that is sometimes seen with use of non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen.

Calprotectin is related to another stool test, lactoferrin. Both are substances that are released by white blood cells in the stool and are associated with intestinal inflammation.

In some cases, calprotectin may be low even when inflammation is present (a false negative). This is most frequently seen with children.

Can a blood test be substituted for a stool calprotectin test?

In general, no. There are blood tests used to detect inflammation (CRP, ESR), but they do not provide the same information about gastrointestinal inflammation as the stool calprotectin test.

What can I do to decrease my calprotectin?

Calprotectin is a reflection of gastrointestinal inflammation and is not affected by lifestyle changes. If it is due to an infection, then it will most likely return to normal when the infection resolves. If it is due to inflammatory bowel disease, then it will rise and fall with disease activity. In the rare case that an elevated calprotectin is caused by non-steroidal anti-inflammatory drug (NSAID) therapy, then it is likely to return to normal when the medication is discontinued.

How long will it take for my calprotectin results?

That depends on the laboratory performing the test. This test is somewhat specialized and is not offered by all laboratories. Your sample will likely be sent to a reference laboratory for testing and it may take several days before results are available.

View Sources

Sources Used in Current Review

Rowe, W. and Lichtenstein, G. (2016 June 17 Updated). Inflammatory Bowel Disease Workup. Medscape Drugs and Diseases. Available online at http://emedicine.medscape.com/article/179037-workup#c6. Accessed on 1/22/17.

Walsham, N. and Sherwood, R. (2016 January 28). Fecal calprotectin in inflammatory bowel disease. Clin Exp Gastroenterol. 2016; 9: 21–29. Available online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4734737/ Accessed on 1/22/17.

Douglas, D. (2016 January 04). Fecal Calprotectin Level Not Consistent in IBD. Reuters Health Information. Available online at http://www.medscape.com/viewarticle/856661. Accessed on 1/22/17.

Zhulina, Y. et. al. (2016). The Prognostic Significance of Faecal Calprotectin in Patients With Inactive Inflammatory Bowel Disease. Aliment Pharmacol Ther. 2016;44(5):495-504. Available online at http://www.medscape.com/viewarticle/867381. Accessed on 1/22/17.

(2016 November Updated). Inflammatory Bowel Disease – IBD. ARUP Consult. Available online at https://arupconsult.com/content/inflammatory-bowel-disease. Accessed on 1/22/17.

(November 21, 2015) American Academy of Pediatrics. Irritable Bowel Syndrome (IBS) and Inflammatory Bowel Disease (IBD). Available online at https://www.healthychildren.org/English/health-issues/conditions/abdominal/Pages/Irritable-Bowel-Syndrome-IBS-and-Inflammatory-Bowel-Disease-IBD.aspx. Accessed March 5, 2017.

Sources Used in Previous Reviews

Caccaro, R. et. al. (2012). Clinical Utility of Calprotectin and Lactoferrin in Patients With Inflammatory Bowel Disease. Medscape Today News from Expert Rev Clin Immunol v8 (6):579-585 [On-line information]. Available online at http://www.medscape.com/viewarticle/771596. Accessed February 2013.

Manz, M. et. al. (2012). Value of Fecal Calprotectin in the Evaluation of Patients With Abdominal Discomfort, An Observational Study. Medscape Today News from BMC Gastroenterol. v12 (5) [On-line information]. Available online at http://www.medscape.com/viewarticle/761448 Accessed February 2013.

Henderson, P. et. al. (2012). The Diagnostic Accuracy of Fecal Calprotectin During the Investigation of Suspected Pediatric Inflammatory Bowel Disease. Medscape Today News from Am J Gastroenterol. v107 (6):941-949 [On-line information]. Available online at http://www.medscape.com/viewarticle/766411. Accessed February 2013.

Gundling, F. et. al. (2011). Fecal Calprotectin is a Useful Screening Parameter for Hepatic Encephalopathy and Spontaneous Bacterial Peritonitis in Cirrhosis. Medscape Today News from Liver International v31 (9):1406-1415 [On-line information]. Available online at http://www.medscape.com/viewarticle/757918. Accessed February 2013.

Sherwood, R. (2012). Faecal Markers of Gastrointestinal Inflammation. Medscape Today News from J Clin Pathol. v65 (11):981-985 [On-line information]. Available online at http://www.medscape.com/viewarticle/773411. Accessed February 2013.

Prakash, R. and Mullen, K (2011). Intestinal Inflammation, Key to Complications in Cirrhosis. Medscape Today News from Nat Rev Gastroenterol Hepatol v8 (12):665-667 [On-line information]. Available online at http://www.medscape.com/viewarticle/754868. Accessed February 2013.

Hashash, J. and Regueiro, M. (2012). The Evolving Management of Postoperative Crohn’s Disease. Medscape Today News from Expert Rev Gastroenterol Hepatol v6 (5):637-648 [On-line information]. Available online at http://www.medscape.com/viewarticle/772973. Accessed February 2013.

DuPont, H. (2012). Approach to the Patient With Infectious Colitis. Medscape Today News from Curr Opin Gastroenterol. v28 (1):39-46. [On-line information]. Available online at http://www.medscape.com/viewarticle/755614. Accessed February 2013.

(2011 April 30). Diagnosing and Managing IBD. Crohn’s and Colitis Foundation of America [On-line information]. Available online at http://www.ccfa.org/resources/diagnosing-and-managing-ibd.html. Accessed February 2013.

Tebo, A. (2013 January). Inflammatory Bowel Disease – IBD. ARUP Consult [On-line information]. Available online at http://www.arupconsult.com/Topics/IBD.html?client_ID=LTD. Accessed February 2013.

(© 1995–2013). Calprotectin. Mayo Clinic Mayo Medical Laboratories [On-line information]. Available online at http://www.mayomedicallaboratories.com/test-catalog/Overview/91597 through http://www.mayomedicallaboratories.com. Accessed February 2013.

Juckett, G. (2011 November 15). Evaluation of Chronic Diarrhea. Am Fam Physician. v84 (10):1119-1126. [On-line information]. Available online at http://www.aafp.org/afp/2011/1115/p1119.html. Accessed February 2013.

Wilkins, T. et. al. (2011 December 15). Diagnosis and Management of Crohn’s Disease. Am Fam Physician. v84 (12):1365-1375. [On-line information]. Available online at http://www.aafp.org/afp/2011/1215/p1365.html. Accessed February 2013.

Sidhu, R. et. al. (2010). Faecal Lactoferrin – A Novel Test to Differentiate between the Irritable and Inflamed Bowel? Medscape Today News from Aliment Pharmacol Ther. v31 (12):1365-1370. [On-line information]. Available online at http://www.medscape.com/viewarticle/723031. Accessed February 2013.

Manohara, J. et. al. (2009 January). Fecal Calprotectin and Lactoferrin as Noninvasive Markers of Pediatric Inflammatory Bowel Disease. Journal of Pediatric Gastroenterology & Nutrition v48 (1): 48-54. [On-line information]. Available online through http://journals.lww.com. Accessed February 2013.

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