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Test ID CALPR Calprotectin, Feces

Useful For

Evaluation of patients suspected of having a gastrointestinal inflammatory process

 

Distinguishing inflammatory bowel disease (IBD) from irritable bowel syndrome (IBS), when used in conjunction with other diagnostic modalities, including endoscopy, histology, and imaging

Method Name

Enzyme-Linked Immunosorbent Assay (ELISA)

Reporting Name

Calprotectin, F

Specimen Type

Fecal


Advisory Information


 



Specimen Required


Supplies: Stool container, Small (Random), 4 oz Random (T288)

Submission Container/Tube: Stool container (T288)

Specimen Volume: 5 g

Collection Instructions:

1. Collect a fresh random stool specimen, no preservatives.

2. Specimens may be stored refrigerate for up to 72 hours following collection. Specimens must be frozen within 72 hours of collection and remain frozen throughout the shipping process.

3. Separate specimens must be submitted when multiple tests are ordered. Specimen must be split prior to freezing for transport. Testing cannot be added on to a previously collected specimen.

4. Specimen cannot be collected from a diaper.


Specimen Minimum Volume

1 gm

Specimen Stability Information

Specimen Type Temperature Time
Fecal Frozen 7 days

Clinical Information

Calprotectin, formed as a heterodimer of S100A8 and S100A9, is a member of the S100 calcium-binding protein family. It is expressed primarily by granulocytes and, to a lesser degree, by monocytes/macrophages and epithelial cells. In neutrophils, calprotectin comprises almost 60% of the total cytoplasmic protein content. Activation of the intestinal immune system leads to recruitment of cells from the innate immune system, including neutrophils. The neutrophils are then activated, which leads to release of cellular proteins, including calprotectin. Calprotectin eventually translocates across the epithelial barrier and enters the lumen of the gut. As the inflammatory process progresses, the released calprotectin is absorbed by the fecal material before it is excreted from the body. The amount of calprotectin present in the feces is proportional to the number of neutrophils within the gastrointestinal mucosa and can be used as an indirect marker of intestinal inflammation.

 

Calprotectin is most frequently used as part of the diagnostic evaluation of patients with suspected inflammatory bowel disease (IBD). Patients with IBD may be diagnosed with Crohn disease or ulcerative colitis. Although distinct in their pathology and clinical manifestations, both are associated with significant intestinal inflammation. Elevated concentrations of fecal calprotectin may be useful in distinguishing IBD from functional gastrointestinal disorders, such as irritable bowel syndrome (IBS). When used for this differential diagnosis, fecal calprotectin has sensitivity and specificity both of approximately 85%. However, it must be remembered that increases in fecal calprotectin are not diagnostic for IBD, as other disorders such as celiac disease, colorectal cancer, and gastrointestinal infections, may also be associated with neutrophilic inflammation.

Reference Values

≤50.0 mcg/g (Normal)

50.1-120.0 mcg/g (Borderline)

≥120.1 mcg/g (Abnormal)

Reference values apply to all ages.

Interpretation

Calprotectin concentrations of 50.0 mcg/g and lower are not suggestive of an active inflammatory process within the gastrointestinal system. For patients experiencing gastrointestinal symptoms, consider further evaluation for functional gastrointestinal disorders.

 

Calprotectin concentrations between 50.1 and 120.0 mcg/g are borderline and may represent a mild inflammatory process, such as in treated inflammatory bowel disease (IBD) or associated with NSAID or aspirin usage. For patients with clinical symptoms suggestive of IBD, retesting in 4 to 6 weeks may be indicated.

 

Calprotectin concentrations of 120.1 mcg/g and higher are suggestive of an active inflammatory process within the gastrointestinal system. Further diagnostic testing to determine the etiology of the inflammation is suggested.

Clinical Reference

1. Gisbert JP, McNicholl AG, Golmollon F: Questions and answers on the role of faecal calprotectin as a biological marker in inflammatory bowel disease. Digest Liver Dis 2009;41:56-66

2. Campeotto F, Butel MJ, Kalach N, et al: High faecal calprotectin concentrations in newborn infants. Arch Dis Child-Fetal 2004;89:F353-F355

3. Dabritz J, Musci J, Foell D: Diagnostic utility of faecal biomarkers in patients with irritable bowel syndrome. World J Gastroentero 2014;20(2):363-375

4. Fagerberg, UL, Loof L, Merzoug RD, et al: Fecal calprotectin levels in healthy children studied with an improved assay. J Pediatr Gastr Nutr 2003;37:438-472

Day(s) and Time(s) Performed

Monday through Friday; 8 a.m.

Analytic Time

3 days

CPT Code Information

83993

LOINC Code Information

Test ID Test Order Name Order LOINC Value
CALPR Calprotectin, F 38445-3

 

Result ID Test Result Name Result LOINC Value
CALPR Calprotectin, F 38445-3

Test Classification

This test has been cleared or approved by the U.S. Food and Drug Administration and is used per manufacturer's instructions. Performance characteristics were verified by Mayo Clinic in a manner consistent with CLIA requirements.

Forms

If not ordering electronically, complete, print, and send 1 of the following forms with the specimen:

General Request Form (T239) (http://www.mayomedicallaboratories.com/it-mmfiles/general-request-form.pdf)

Gastroenterology and Hepatology Test Request Form (T728) (http://www.mayomedicallaboratories.com/it-mmfiles/gastroenterology-and-hepatology-test-request.pdf)