You can&#;t be diagnosed with Crohn&#;s or Colitis from just one test. Your doctor will need to gather lots of information to find out why you&#;re unwell. This can sometimes take time but it&#;s important you get the right diagnosis. The symptoms of Crohn&#;s and Colitis may be like other conditions, such as irritable bowel syndrome (IBS). To help understand what&#;s going on in your body, your GP will consider all your symptoms, together with some early investigations. These might include an examination of your tummy, as well as tests on your blood and poo.  Your GP may also send you to have endoscopies, scans or X-rays. These are all tests to look inside your body.

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Physical examination

Your GP might examine your tummy (abdomen) area to check for any lumps or to see if it&#;s tender. They may also check your bottom for piles, also known as haemorrhoids. You can request a doctor who&#;s the same sex as you, or you can ask for a chaperone for your examination. A chaperone is someone who can go with you to your examination and is usually the same sex as you, is impartial and does not know you.

Blood tests

Blood tests can show several different things. They can be used to see if you have inflammation in your body. They can also show if you&#;re low in iron, known as anaemia, or if you lack certain vitamins. Anaemia could suggest that you&#;re not absorbing the right nutrients or that you have small amounts of bleeding somewhere in your gut. These are both common in Crohn&#;s and Colitis. Your GP can also order a special blood test to check for signs of Coeliac disease. Coeliac disease is an immune condition that becomes worse when you eat foods that contain gluten. The symptoms of Coeliac disease can be like the symptoms of Crohn&#;s and Colitis. You can take Coeliac UK's online assessment to see if you should be tested for the condition.

Tell the doctor or nurse before your test if you&#;re worried about needles or seeing blood. They can make sure you&#;re as comfortable as possible and answer any questions you have.

Stool (poo) tests

Your poo might be tested for signs of bleeding or inflammation. It may also be checked for infections, like a Clostridium difficile infection, often known as C.Diff. For these tests, also called stool or faecal tests, you&#;ll need to collect a sample of your poo in a clean, dry screw-top container. Your doctor will give you this container and let you know what to do with it. You can find out more on how to collect and store a poo sample on the NHS website.

The thought of needing to give a sample of poo can be off-putting. But these sorts of tests are incredibly useful. They can help with your diagnosis, which means that you get the right sort of treatment for you.

Faecal calprotectin tests

Your GP may arrange for your poo to be tested for something called faecal calprotectin. Faecal calprotectin tests can show if there&#;s inflammation in your gut. This can be a sign that you may have Crohn&#;s or Colitis. However, a high faecal calprotectin result can also be caused by other issues, such as diarrhoea from an infection, gastroenteritis or certain types of cancerous and non-cancerous tumours.

Usually, levels that are above 100ug/g (micrograms of calprotectin per gram of poo) are considered to be a raised level. Higher levels may suggest that you should have further tests for Crohn's or Colitis. Not all hospitals and clinics use the same cut-off point of 100ug/g.

Lower levels of faecal calprotectin could indicate that you have irritable bowel syndrome or another non-inflammatory condition. However, lower levels can&#;t completely rule out Crohn&#;s or Colitis. You may have a repeat test after 6 weeks if your symptoms carry on.

A faecal calprotectin test may not be helpful for diagnosing Microscopic Colitis. For this condition, faecal calprotectin levels are often quite low.

Faecal calprotectin tests in children

Just like adults, faecal calprotectin tests are sometimes used to help diagnose Crohn&#;s or Colitis in children and young people aged under 18. See above for more information.

A child&#;s calprotectin levels may be assessed by a specialist in a hospital or clinic, rather than a GP.

There are no agreed cut-off levels that reliably show inflammation in children. Sometimes, the same faecal calprotectin cut-off levels as an adult might be used in children over four. But these will be used cautiously.

Children&#;s levels of calprotectin may be naturally higher than an adult&#;s and can vary. This can make it difficult to interpret, particularly in children younger than six.

To help with diagnosis, these tests may be used alongside a list of the child&#;s symptoms. Using both can help give a full picture of what&#;s going on.

Faecal immunochemical test (FIT)

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Generally, if you&#;re older than 60, your GP may not use the faecal calprotectin test. This is because they may want to rule out other conditions, such as bowel cancer. Some hospitals and clinics may not use the faecal calprotectin test for some people with certain symptoms under 60 years old.

Your GP might use a FIT or faecal immunochemical test instead. This can check for small amounts of blood in your poo. Blood in the poo does not always mean a person has cancer. A FIT test may show blood in your poo due to something else, such as Crohn&#;s or Colitis.

What is the Fecal Calprotectin Test?

Written by: CDHF

Updated: November 16th,

Fecal Calprotectin Test: A biomarker of intestinal inflammation

Your stool has a story to tell &#; good or bad &#; about what&#;s happening in your body.

When a person has inflammation of the bowel, neutrophils and other inflammatory cells release a cytosolic protein called calprotectin. The fecal calprotectin test is a non-invasive stool test that involves the collection and analysis of your stool to measure the amount of the calprotectin in it.

The fecal calprotectin test is often used to differentiate between irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD). 

IBS and IBD are two conditions with common symptoms such as diarrhea, abdominal bloating, and cramping, but are in fact quite different and have very different treatment options.

• IBS is a disorder affecting the intestine. IBS involves problems with motility (movement of digested food through the intestines) and sensitivity (how the brain interprets signals from the intestinal nerves), leading to abdominal pain, changes in bowel patterns and other symptoms. IBS is a functional gut disorder. Functional means that the affected area (intestines) are impaired and not working the way they should, however there are no visible abnormalities that can be observed through testing. IBS symptoms are commonly controlled through diet, and lifestyle changes and in more severe cases, medication.
• IBD is at least two separate disorders that cause inflammation (redness and swelling) and ulceration (sores) of the small and large intestines. These two disorders are called ulcerative colitis and Crohn&#;s disease and symptoms can range from mild to debilitating, and even life-threatening. Since the disease is not curable, long-term treatment is often required.

Not only is the fecal calprotectin used to distinguish between IBD and non-inflammatory disorders such as IBS, but if you have already been diagnosed with IBD, it can be used to monitor your IBD. This includes:

• Assessing response to treatment,
• assessing mucosal healing,
• and even predicting flares!

How does the fecal calprotectin accurately diagnose or monitor IBD?

After your stool is analyzed, your doctor will look at your test results and determine whether your levels of calprotectin are normal (low), borderline(moderate), or abnormal (high). A high level can indicate IBD, whereas a lower level can indicate a functional bowel disease such as IBS.

Let&#;s take a closer look at the levels:

• Low or normal levels (< or =50.0 mcg/g) may indicate that that there is no inflammation, and you are in remission OR if you are having symptoms, that these symptoms are not caused by inflammation (i.e caused by irritable bowel syndrome or some other cause). Knowing this will help to exclude IBD, and avoid unnecessary referrals and colonoscopies.
• Moderate or borderline levels (50.1-120.0 mcg/g) can indicate that some inflammation is present and could be due to treated inflammatory bowel disease (IBD) or associated with the usage of nonsteroidal anti-inflammatory drugs (NSAID), aspirin, or proton-pump inhibitors. For patients with moderate levels and clinical symptoms suggestive of IBD, retesting in 4 to 6 weeks may be needed.
• High or abnormal levels (> or =120.1 mcg/g) can suggest that you have active inflammation. High levels don&#;t always explain the reason for inflammation so your doctor may order additional tests. An endoscopy (colonoscopy or sigmoidoscopy) may be indicated as a follow-up test to help determine the cause of inflammation, signs, and symptoms.

What are the other testing options?

Diagnosing IBD is normally 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 kind of testing can be invasive, and is less likely to be necessary if inflammation is not present &#; so the fecal calprotectin test is a great, less-invasive option to confirm. (1)

There are blood tests used to detect inflammation, but they do not provide the same information about inflammation as the fecal calprotectin test, or the location of the inflammation. It&#;s important to note that calprotectin is a reflection of intestinal inflammation and is not affected by lifestyle changes. If its due to an infection, then it will most likely return to normal when the infection goes away. If it is fact due to IBD, then it will rise and fall when you are in remission or in a flare.

You can develop IBS or IBD at any age. If you are experiencing persistent symptoms such as bloody or watery diarrhea, abdominal cramps, with or without fever, or are looking to proactively monitor your condition, CDHF recommends talking to your doctor to decide if the fecal calprotectin test is an option for you.

Watch our CDHF Talk with Dr. Karen Kroeker from the University of Alberta who explains the important role stool tests play in diagnosis and treatment of digestive disorders.

References:

(1) Journal of Clinical Gastroenterology: March &#; Volume 55 &#; Issue 3 &#; p 239-243 doi: 10./MCG.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC/

https://www.mayocliniclabs.com/test-catalog/Clinical+and+Interpretive/

https://www.lifelabs.com/test/fecal-calprotectin-testing/?gclid=Cj0KCQiAys2MBhDOARIsAFf1D1fRD7BVl80FFYwbmyAYOFJEmoGh0XqK2YbTWDZ5n3mi3h63iUvoCigaAtPBEALw_wcB

https://pubmed.ncbi.nlm.nih.gov//#:~:text=Conclusions%3A%20Fecal%20calprotectin%20may%20be,pattern%2C%20compared%20with%20ileal%20CD.

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