How many have GI's in the US that use feacal calproetectin?

I had my routine GI visit today. I've been having pretty annoying symptoms. I'm often bloated and feeling constipated and get backed up, but then when I actually have a bowel movement it is soft or D. I have tried every combo of Fiber pills colace, Miralax, and Senokot known to man and it is an ongoing frustration. My blood work looks good. So we were discussing how to differentiate IBS from a Crohn's flare when lab work is normal. I asked about fecal calprotectin and he never heard of it. He said he did just get back from a national conference on IBD, and is thinking that if I get anemic again that maybe we should consider biologics.

I live in a small town, and although my GI is an extremely kind and responsive doc, he is definitely not a Crohn's specialist. If my anemia returns (I'm currently within normal limits but my iron stores are trending downwards), I plan to get a second opinion at U of Chicago. I was just wondering in the interim though, if the fecal calprotectin test could possibly differentiate between IBS and Crohn's? My CRP is normal right now, and my Sed rate is only at 12. The sed rate for me is normally at 1 or 2 ( I have no arthritis) but still, 12 is a pretty low number. Any thoughts???

Hi Kazbern,
I have a lot of fear about biologics, but certainly will consider it if it is necessary. I didn't do well when I tried 6MP....had raised liver enzymes, so we don't want to try that again. So if this is just IBS, then I don't want to over-react. But if I get anemic again, then I think I'm ready to try a different treatment plan. I just don't want my GI to start biologics on his own....I think I'd feel better if I can get an expert opinion. The good news is that I found out my Blue Cross will work in network in Chicago even though I'm from Michigan. I didn't realize that before, so it won't be too costly to go. So, that's my logic at this point. I just thought if the fecal cal test showed inflammation, then I would be satisfied that this isn't just IBS. Maybe my local hospital lab doesn't even do the test.

My best friend asked the same question. I don't want to go until I'm ready to do what they recommend, and I think I'm just not ready.....it's probably more of an emotional answer than a logical one. I had the whole cat bite/ c. diff fiasco in September, and I'm wondering if I'm still recovering from post infectious IBS. I guess I want to see if things settle down or get worse.

Thanks NCOT,
I read through that test and I noticed that people with known IBD were excluded from the study: "Exclusions
Studies of faecal calprotectin for monitoring activity, or response to treatment, in people with known IBD."

I have a definite Crohn's diagnosis already. I was trying to figure out if the feacal calprotectin test could be used to determine if my Crohn's is active or in remission, because I don't think for me, basing it on symptoms is helpful. In the UK, do they use the Fecal Cal test for ongoing monitoring after a diagnosis is already determined? It sounds like that's what they are doing with you right now?

Yes, it can.

My GI has done the FCP test for me at least 3 times now, and I have had a Crohn's diagnosis for 13 years. I'm too tired to look up the relevant studies, but there are several which discuss the use of the FCP as a means to measure disease progress in IBD, as opposed to diagnosis.

I have to say, considering the FCP test has been around since 2000, I'm not impressed that your GI hasn't heard of it. It doesn't even seem to be expensive....

the test is cheap, and simple to perform (5 g spot stool sample with commercial ELISA kit)

It's a stool test. It never made much sense to me that it would be too expensive for insurance companies to cover. I just don't think US docs want to give up on their lucrative colonoscopies.

Put the link in between [ url] and [ /url] tags, but remove the spaces: I'm just putting them there so the tags don't render invisibly.

And yeah, faecal calprotectin does seem to be better at predicting relapse in UC or colonic Crohn's than in pure ileal disease. What's not made clear for me in that article is whether FCP is raised during active ileal disease. If it isn't, then it seems like it would be a worthless test for small bowel Crohn's disease. But I find that hard to believe. Especially as my GI ordered a FCP test for me, knowing I no longer have a colon.

Thanks for the help with the hyperlink! I think I'll bring the article for my doc, since he genuinely seemed interested. My guess is that my hospital lab may not perform the test.

Hi Gumby...checking in on you...and it sounds like we still need to get you taken care of!
I don't live in a small town, but my GI does not bring up the FCP test ever. As a matter of fact, I think I educate him often---newish doc and I tend to point him to thoughts and he goes and investigates.
As for BCBS plans, most have BlueCard that allows you to have a network around the country...it may not be as strong a discount as you get in your area, but you are still in network. Also, before you take the initial NO on the test, talk to someone at your insurer (yeah that old thing from me again). You may be able to present a need and point out that it is cheaper than other options and may prevent you from starting costly meds.

I'm surprised that a simple stool test is not widely available in the US. Especially one which, while not perfect, still correlates with inflammation a lot more reliably than blood tests do. A lot of people have normal bloodwork during flare-ups; my GI even told me this, but I knew it anyway from various posts I've read.

I'd be miffed if I couldn't have a FCP test. I think it's worth pursuing further at this stage.

Perhaps w/colon involvement the number range is indicative or more accurately indicative of inflammation activity.

For the small intestine what we used it for was just if the numbers were going up or going down between tests. That proved very accurate.

The FCP was first offered in the US by the "old" Great Smokies lab in the SE US. I can't remember what they've changed their name to. At that time Great Smokies were best known amongst the homeopathic practitioners. They changed their name or were bought out or whatver and became more mainstream.

Gumby - your delay tactics smack of denial to me. You know how Crohn's can simmer and cause significant damage to the gut if left on its own. Please give yourself the gift of getting in front of this problem. You can get your DR's office to do the legwork on finding the right lab and talking to your insurance, too. That is what they are supposed to do.

I went to a destination wedding with a flare a few years ago. We were in Mexico, at an all-inclusive resort. I didn't eat much but it was still fun! I hope you can enjoy your vacation. Happy anniversary!

Yeah, what kazbern said. You need to find out if you have currently active inflammation - not whether or not FCP can accurately predict a relapse. That's just trying to read the future and isn't massively important, imo. It's untreated inflammation which does all the damage in Crohn's and it can take years before it shows up.

Try to get your doctor onboard for this, and then hopefully his office can deal with the administrative side of things. I think it's a bit disgusting that patients have to spend hours on the phone wrangling with insurance companies; but then I have seen other people say that their doctor does all that for them. So... try to get somebody else to do the legwork if you can.

Happy 30th wedding anniversary, by the way! :p I hope you manage to have a nice vacation. 30 years together is something worth celebrating (at least if you like your husband it is >_>).