Raised fecal calprotectin
| HOSP # | WARD | GIT clinic | |
| CONSULTANT | Dr. Heleen Vreede | DOB/AGE | 59 y male |
Abnormal Result
Faecal calprotectin >6000 ug/g stool
Presenting Complaint
59 y male, presenting with diarrhoea and bloody mucus per rectum
History
This is a 59 year old male known with ulcerative colitis proctitis who now has a suspected flare.
Ulcerative colitis (pancolitis) diagnosed 2009.
Histological history
2017: Mild focal active colitis noted on Histology
2019: Sections of rectal mucosa showed features of active chronic proctitis. The crypts showed distortion with focal areas of crypt abscesses noted. The lamina propria was expanded by reactive polymorphous mature lymphocytes with conspicuous eosinophils.
Examination
Unknown
One would look for especially extra-intestinal manifestations of Ulcerative Colitis
Laboratory Investigations
Histology: Sections of colon demonstrate a severe acute colitis with cryptitis , crypt abscess and numerous neutrophils in the lamina propria on a background of chronic changes illustrated by architectural disarray and glandular atrophy.
Other Investigations
Apart from the colonoscopy and histology, one needs to evaluate for other autoimmune disorders in the gastro-intestinal tract, especially complications of primary sclerosing cholangitis. No biochemical signs thereof was present.
| Test (units) | Result |
| Creat (umol/L) | 122 H |
| MDRD | 53 |
| CKD-EPI | 56 |
| Alb (g/L) | 44 |
| Total bili (umol/L) | 4 L |
| Conj bili (umol/L) | 2 |
| ALT (U/L) | 18 |
| AST (U/L) | 30 |
| ALP (U/L) | 77 |
| GGT (U/L) | 16 |
| CRP (U/L) | 2 |
Final Diagnosis
Inflammatory Bowel Disease (Ulcerative colitis)
Take Home Message
We have in recent years started to offer this test. One of our recently qualified pathologists, Dr. Justine Cole, was responsible for the method validation of this assay at our laboratory. There were quite a few difficulties with the validation, mainly due to stool being a difficult to work with matrix and sample stability when transported.
In summary:
Faecal calprotectin is excreted in excess into the intestinal lumen during the inflammatory process and so can act as a marker for inflammatory diseases of the lower gastrointestinal tract. Faecal calprotectin testing is recommended in patients with recent onset lower gastrointestinal symptoms, if cancer is NOT suspected, for the
differential diagnosis of inflammatory bowel disease (IBD e.g., Chrohn’s disease, ulcerative colitis) or irritable bowel syndrome (IBS).
Faecal calprotectin <=50 ug/g stool is negative, i.e., supports IBS.
Faecal calprotectin >50 ug/g stool is positive, i.e., supports IBD.