Faecal calprotectin 809 ug/g Above high reference limit but normal bloods and past colonoscopy/ MRI normal

[Jutme]

Hello

Not sure if anyone can help, but I recently did aFaecal calprotectin test which came back high at 809 ug/g. However all my bloods were normal including CRP. I also had a colonoscopy, MRI and capsule endoscopy in 2021 and all came back normal. So have been diagnosed with IBS- D by gastroenterologist. My symptoms worsened in December. The gastroenterologist suggested repeating faecal calprotectin and bloods through my GP which I did in Jan this year. Which is when my faecal calprotectin came back high. I trying to get my gp to send the results to my gastroenterologist as I want to see what they advise. I have been referred for a colonoscopy but still waiting to hear. I would like to know what peoples thought on this is considering my colonoscopy was clear in 2021. Can IBS cause the high calprotectin? If I do get a colonoscopy appointment is it worth repeating? I am worried about my results but would crp not be raised too if its IBD. What else could causes this?

thank you, any advise would be much appreciate

[Viklou]

Raised calprotectin can be caused by several things and often bloods can be normal and calprotectin raised. It's definitely worth repeating the tests again as things can change quickly. It took me around 6 years to get a diagnosis of small bowel Crohn's and that was only found on pill cam.

[xjrs]

It has been scientifically proven that a low fibre/carb, high protein diet can cause inflammation in the body. I had a normal calprotectin the year before I was put on a low fibre/carb, high protein diet by nutritional therapists (none of which I will ever use again). What is your diet like? I know it is very difficult with IBS not to restrict diet. However, severe dietary restrictions can make IBS worse which is catch 22.

I am not sure if this is true in your case, but if it is, my first go to to improve food tolerance is to try a probiotic such as Alflorex on a 3 month trial to re-address the balance of gut microbes, since a dominance of bad bugs can cause symptoms. Once symptoms die down, food tolerance increases; as you eat more foods, bacterial diversity increases, which increases the number of good bugs that can fight off the bad. There is also the Nerva gut directed hypnotherapy app that can be used in parallel, since there can also be a connection with the gut/brain access. Failing those there is the FODMAP elimination and reintroduction diet via dietitian referral - I would do this as a last resort, due to the food restrictions already described. If all these fail you could ask for a test for BAM (bile acid malabsorption). If probiotics after a good trial make symptoms far worse, you may have one of the very rare cases of SIBO (small intestine bacterial overgrowth), but this only happens if you have one of the set causes of it - all of this would need discussing with your GP/gastro.

[Icanchangethislater]

The fecal calprotectin test is used to differentiate between IBS and IBD, so you would not get a high calprotectin with IBS. As an aside, the use of PPIs is associated with elevated calprotectin levels.