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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


Shipping Instructions


Preferred shipping temperature is frozen. Refrigerated or thawed specimens received more than 72 hours postcollection will be rejected.



Specimen Required


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

Submission Container/Tube: Stool container

Specimen Volume: 5 g

Collection Instructions:

1. Collect a fresh random fecal specimen, no preservative.

2. If specimen is sent refrigerate, send immediately after collection.

3. If specimen cannot be sent immediately, freeze and send frozen (preferred).

Additional Information:

1. Separate specimens must be submitted when multiple tests are ordered. Specimen must be split prior to transport.

2. Testing cannot be added on to a previously collected specimen.


Specimen Minimum Volume

1 g

Specimen Stability Information

Specimen Type Temperature Time Special Container
Fecal Frozen (preferred) 7 days
  Refrigerated  72 hours

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 is eventually translocated across the epithelial barrier and enters the lumen of the gut. As the inflammatory process progresses, the released calprotectin is absorbed by 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 nonsteroidal anti-inflammatory drug (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

5. Sherwood RA, Walsham NE, Bjarnason I: Gastric, pancreatic, and intestinal function. In: Rifai N, Horwath AR, Wittwer CT, eds. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. 6th ed. Elsevier; 2018:1398-1420

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, approved or is exempt 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 (T239)

-Gastroenterology and Hepatology Client Test Request (T728)

Mayo Clinic Laboratories | Gastroenterology Catalog Additional Information:

mml-gi-ibd, mml-gi-ibd-diagnosis