Thru our years of use my gastro and I have come to the conclusion that the fecal calprotectin test is more valuable in indicating the trend of our current disease activity than in the severity of it. Is our disease responding to medication or is it increasing in activity?
Magne Fagerhol, who was the principal or one of the major principals in the development of the fecal calprotectin test to determine inflammation activity in the intestines, had intended that the PATIENT be given several calprotectin kits to have on hand so that the PATIENT could determine when and if a test needed to be run. He also intended that it be an inexpensive test a patient could afford to pay for out of pocket if necessary. Great Smokies Lab down in the SE (NC maybe?) was the first US commercial lab to offer the fecal calprotectin test.
When we were doing the early calprotectin tests w/Great Smokies the "kit" consisted of a rubber glove, a plastic form to hold the tub over the toilet bowl, the tub to catch the stool, a tongue depressor to "transfer" at bit o the beginning of the stool, a bit of the middle and a bit of the end of the stool and mix it well in the provided "culture cup", the cup was then put in a marked plastic bag which was then inserted in a labeled and addressed bag and the patient shipped it off shipping prepaid to Great Smokies. Back then the billing cost was $140 and Medicare and my secondary insurance paid for it.
We haven't had the need to run the calprotectin test in several years and I was caught by surprise when my gastro ordered it at my office visit after my recent hospitalization. No need to get the kit from her anymore, our local hospital lab provided me w/a "culture cup". But nothing else. That rather caught me by surprise. No special instructions, just collect the poop, put it in this cup and bring it back to us. Is that how your lab is doing it?? (Our hospital lab doesn't do the calprotectin test, they send it out to WARDE).
In the early days the reference ranges were as follows:
50 �g Calprotectin/g stool = Normal
50-100 �g Calprotectin/g stool = Moderate GI inflammation
100 �g Calprotectin/g stool = Significant GI inflammation
250 �g Calprotectin/g stool = Mild to moderate IBD activity
500 �g Calprotectin/g stool = Severe IBD activity
(IF I remember correctly those "boxes" are supposed to stand for a symbol that indicates mcg).
The current reference range for WARDE is <=162.9 mcg/g
As far as CRP - my Sed Rate is often elevated when my CRP is not. I've had a Sed Rate of 140 (reference range 0-30) w/no raise in CRP. On the other hand I've had a Sed Rate of 44 (reference range 0-30) and a CRP of 5.89 (reference range 0.00 - 0.75).
CRP: Elevated CRP levels can be caused by any condition that results in acute inflammation. A C-reactive protein test is most commonly done to monitor the activity of certain inflammatory conditions. These conditions include .... inflammatory bowel disease .... and rheumatoid arthritis.
ESR: A sedimentation rate (sed rate) test is done to help determine whether a condition causing inflammation is present. A high sedimentation rate (sed rate) may indicate inflammation caused by an infection. Some diseases that cause inflammation do not increase the sed rate, so a normal sed rate does not always rule out a disease. An ESR may help detect certain inflammatory diseases when CBC results are normal. ESR levels increase about a week after the start of inflammation. CRP testing can detect inflammation sooner than an ESR.