Fecal calprotectin?

My Daughter still seems to be struggling with certain issues of late. She's had low hemoglobin and iron for some time now, and has had an iron infusion recently. She may have to have another one, as her iron still isn't where it should be, although higher.

She just got the results of her fecal calprotectin test, which came back very high. Not sure of the number. Her other inflammation markers are showing normal though. Also, she's not showing any Remicade in her body, and her IBD nurse is suspecting she is now failing Remicade after 10 years. She's scheduling a rush colonoscopy hopefully in the next week or so, then meets with her GI on Dec. 05th.

My guess is, they'll either up her Remicade and go to every 6 weeks, or transition to another anti-TNF. It will likely be either Humira or Stelara. Hoping for the best.

I was going to say what beave said. They also may increase the dose. I'm at 10 mg/kg every 6 weeks.

That's good they're getting her in so fast.

My GI said that fecal calprotectin can be a weird measurement. It can fluctuate frequently even in the same day. So while it's a good benchmark and it's good they are doing a scope, it's not super conclusive if that makes sense.

Hope things go well. <3

I am sorry your daughter is struggling.

I agree with the others regarding increase of dosage/decrease in timing.

At one time your daughter was on dual therapy correct?. Have they had her try the dual therapy again to see if it would drive her antibodies down, causing her body to use less Remicade and thus stabilizing her? This works with some people. It's worth an "ask"....unless her symptoms and quality of life are being impacted in a manner that needs immediate action.

I have had 3 surgeries. I had to go off or delay Remicade. After surgery I did not restart the methotrexate. I started having symptoms of Crohns about 8 weeks after surgery. I started Remicade about 10 to 12 weeks after each surgery. They tested Remicade trough levels and antibody levels. Each time I had very low levels of Remicade or none with an antibody test showing 13.98. This level remained the same on the first 3 infusions after surgery. I started taking methotrexate again, it drove the antibodies down to zero and Remicade levels started rising. Symptoms gradually decreased. Blood work improved. It took another 4 to 6 months for everything to "return to normal". They completed Prometheus tests every other infusion for about six months after my Remicade levels started to rise. GI and Colorectal surgeon stated it does not work for everyone but it does work for a few. You will know pretty quickly if it works...if there is movement on the levels after you restart the second therapy then it usually continues to improve. We are trying this for the 4th time on me. Hopefully it works this time too...

On the fecal test...I had low numbers and a very ulcerated colon..then I had high numbers and a healthy colon..... So for me that just was not a good indicator either of those times. It may help but it's not a complete picture. The scope will show more so that she can find out what she needs to do. It is good that they are being pro active.

Please let us know how it goes. You all are in my thoughts and prayers!
Clo

By 'trough levels,' it means testing for levels if infliximab (remicade) right before it's time for the next infusion, like the day before or even the morning before the infusion. Right after an infusion, the levels would be at their highest. Then they gradually decrease until the next infusion. The lowest point is the 'trough.' Ideally, the patient should still have sufficient levels of infliximab at the trough. If they don't, then they're burning through it or metabolizing it all before their next infusion. So infusion frequency and/or dose amount is increased.

The test for fecal occult blood would be a way to see if there is bleeding going on that isn't showing up as actual visible blood in the stool. Bleeding that she's unaware of could explain the iron deficiency. It's a quick easy and fairly cheap test. But it's not really needed if she's going to have a colonoscopy very soon.

As for fecal calprotectin, it's a measure of inflammation in the gi tract, mostly the colon but to a lesser extent the small bowel. As white blood cells fight and die off, a byproduct is calprotectin, which is washed out of the gi tract in the stool. So a measure of calprotectin is an indirect measure of white blood cell activity, which is an indirect measure of inflammation.

It's a fairly good indicator but not perfect. For some people, it only elevates a little even with severe inflammation. For other people, it skyrockets with only mild inflammation. But overall, if you take the measure for hundreds of patients, the higher the number the more inflammation is found. The best way to know how it tracks for her specifically is to measure it several times over time and see how it correlates, for her, to scope results.

73monte,

How is your daughter? Was she able to get a scope scheduled?.

Clo