How to manage persistently high fecal calprotectin levels?

Question

Hello doctor,

I would like to speak about my issue. I am 39 years old, and for about 7 to 8 years, my fecal calprotectin levels have been around 700 to 800 units, which have remained quite constant.

A doctor suggested checking calprotectin because I experience intestinal issues once or twice per year, such as gas or diarrhea, which usually last one to two weeks.

About two years and one month ago, I underwent a colonoscopy, which was normal. There was no need to take a sample from the intestines. However, I am still having high calprotectin results, even though the colonoscopy was normal. The most recent episode of gas and diarrhea occurred about four months ago.

What should I do?

Kindly help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and understood your concern.

A fecal calprotectin level that stays in the 700 to 800 range for many years is higher than expected and suggests ongoing inflammation somewhere in the digestive system.

The important point is that a normal colonoscopy only shows that the inner lining of the large intestine appears normal, but it does not rule out inflammation in the small intestine, in the deeper layers of the bowel wall, or in areas that the camera cannot reach.

Persistently high calprotectin levels, even when gas or diarrhea occurs only occasionally, can be seen in early or mild Crohn's disease involving the small bowel. It can also be linked to chronic infections, such as Giardia, which may come and go, the use of nonsteroidal anti-inflammatory medications; or less common inflammatory conditions like microscopic colitis or eosinophilic gut disease.

Some of these conditions require biopsies for diagnosis, even when the colon appears normal during colonoscopy. Since biopsies were not taken in your case, it is possible that some of these causes were missed.

The fact that your symptoms appear once or twice a year and then settle does not exclude these possibilities, because inflammation can continue silently between episodes.

At this stage, I suggest you focus on evaluating the parts of the digestive tract that were not examined. I suggest you undergo the following:

Magnetic resonance enterography or CT (computed tomography) enterography can assess the small intestine and detect Crohn's disease or other small bowel inflammation.
Stool tests for parasites such as Giardia and tests for coeliac disease can also be useful.
A repeat colonoscopy with biopsies, even if the lining looks normal, is needed if microscopic colitis is suspected.

Since your calprotectin levels have been consistently high for years, it is reasonable to see a gastroenterologist again and request further evaluation of the small bowel.

If you wish, you can share whether you use any anti-inflammatory pain medications, whether you have joint pain, skin issues, weight changes, or a family history of bowel disease, and more specific guidance can be provided.

I hope this helps.

Kindly follow up if you have more doubts.

Thank you.