Explanation

Calprotectin (stool): what is measured?

Calprotectin is a protein from white blood cells (neutrophil granulocytes). When the bowel wall is inflamed, many of these cells end up in the bowel and calprotectin gets into the stool. The test measures how much calprotectin is in a portion of stool. The more inflammation in the bowel, the higher the value.

What can it detect?

Chronic bowel inflammation (inflammatory bowel disease, IBD), such as Crohn's disease and ulcerative colitis
Distinction between bowel inflammation and irritable bowel syndrome (IBS), with recurring diarrhea
Measure of the activity of a known chronic bowel inflammation

Result

What does the result mean?

Calprotectin (stool) too high

A raised calprotectin points to inflammation in the gastrointestinal tract. This can fit a chronic bowel inflammation such as Crohn's disease or ulcerative colitis, especially with symptoms such as long-lasting diarrhea, blood or mucus in the stool and weight loss. A raised value also occurs with a bowel infection, with use of anti-inflammatory painkillers (NSAIDs such as ibuprofen or diclofenac) and with celiac disease. Rarely: a bowel polyp or bowel cancer. According to the guideline, a value above 100 micrograms per gram of stool is positive, and 50 to 100 is a gray area.

Calprotectin (stool) too low

A low value (below 50 micrograms per gram of stool) makes chronic bowel inflammation very unlikely. With recurring abdominal pain and changing stools, this fits irritable bowel syndrome more, a condition that is unpleasant but not dangerous and in which the bowel looks normal. A low value does not rule out other causes of bowel symptoms, such as celiac disease. With very watery stool, the value can be falsely low.

After an abnormal result

With a value above 100 micrograms per gram, the GP refers to a gastroenterologist, according to the guideline; with a value between 50 and 100, the GP first consults the gastroenterologist. With a low value, an endoscopy of the bowel is usually not needed.

Reliability

How reliable is the test?

According to the multidisciplinary guideline on irritable bowel syndrome by GPs (NHG) and gastroenterologists, the calprotectin test is mainly good at ruling out chronic bowel inflammation: in general practice, almost everyone with a negative result does not have bowel inflammation. A positive result is less certain; some people with a raised value turn out not to have a bowel disease on further testing. The guideline uses below 50 as negative, 50 to 100 as a gray area and above 100 micrograms per gram as positive.

What can affect the result?

Anti-inflammatory painkillers (NSAIDs) and a bowel infection can raise the value without chronic bowel inflammation.
With very watery stool, the value can be falsely low.
The various calprotectin tests differ greatly; cut-off and reference values differ between laboratories.
Outside general practice, in groups with many bowel diseases, the test is less reliable for ruling out inflammation.

Who it is for

Who is the test useful for?

Useful for

According to the guideline, useful with recurring diarrhea that has been present for 3 to 6 months and a raised chance of chronic bowel inflammation, for example with a parent, brother, sister or child with Crohn's disease or ulcerative colitis. Also used in people with a known bowel inflammation to monitor its activity. In people without bowel symptoms, the test is not useful. With blood in the stool, unexplained weight loss or new bowel symptoms starting after age 50, the test is no substitute for an examination by the GP.

How common is it?

Irritable bowel syndrome is common: according to the guideline, it affects about 4 in 100 adults in the Netherlands (by the strictest criteria), more often women and at a younger age. Chronic bowel inflammations such as Crohn's disease and ulcerative colitis are much rarer. The guideline gives no Dutch figure for these.

FMS guideline on irritable bowel syndrome (NHG and NVMDL)

Drawbacks and risks

A slightly raised value, for example due to a painkiller or a passing infection, can lead to unnecessary worry or an endoscopy of the bowel.
A low value can give false reassurance about other causes of bowel symptoms that the test does not measure.

Get tested

Calprotectin (stool): test panels

Calprotectin (stool) is part of these test panels. You order online and have your blood drawn at a collection point or collect the sample at home.

Stool
4D Basic Package
Comprehensive basic analysis of intestinal health, including activity measurements and biomarkers.
€ 625,00
Stool
4D Orientation package
Orientation of basic microbial distribution in the gut, including main groups and activities.
€ 220,00
Stool
4D Specialist package
Comprehensive gut health analysis for patients with complex health problems.
€ 975,00
Stool
4D Extended package
In-depth investigation of gut health, biodiversity, and biomarkers for persistent complaints.
€ 750,00
Stool
Basic bowel screening
Investigation of gut microbiota, digestion, inflammation, Leaky Gut, dysbiosis, and food allergy.
€ 335,00
Stool
Calprotectin
Measures inflammatory marker in stool. Indication for inflammation and IBD-severity.
€ 75,00
Stool
Closed Gut/Leaky Gut screening and mucosal immunity
Distinguishes Closed Gut from Leaky Gut. Analyzes mucosal integrity and gut immunity.
€ 285,00
Stool
Gut therapy screening
Comprehensive screening of intestinal function and microbiome. Includes 15+ test parameters.
€ 900,00
Stool
Inflammation screening
Qualitative screening for inflammatory parameters in stool. Suitable for suspected inflammatory bowel disease.
€ 175,00

Evidence

Sources

This explanation is based on Dutch guidelines and independent information. It is general information, not a diagnosis. Discuss an abnormal result with your GP.

More about risks and results

More explanations

Other tests: Gut

All tests

Calprotectin (stool)

Calprotectin (stool): what is measured?

What can it detect?

What does the result mean?

Calprotectin (stool) too high

Calprotectin (stool) too low

After an abnormal result

How reliable is the test?

What can affect the result?

Who is the test useful for?

Useful for

How common is it?

Drawbacks and risks

Calprotectin (stool): test panels

4D Basic Package

4D Orientation package

4D Specialist package

4D Extended package

Basic bowel screening

Calprotectin

Closed Gut/Leaky Gut screening and mucosal immunity

Gut therapy screening

Inflammation screening

Sources

Other tests: Gut

Calprotectin (stool)

Calprotectin (stool): what is measured?

What can it detect?

What does the result mean?

Calprotectin (stool) too high

Calprotectin (stool) too low

After an abnormal result

How reliable is the test?

What can affect the result?

Who is the test useful for?

Useful for

How common is it?

Drawbacks and risks

Calprotectin (stool): test panels

4D Basic Package

4D Orientation package

4D Specialist package

4D Extended package

Basic bowel screening

Calprotectin

Closed Gut/Leaky Gut screening and mucosal immunity

Gut therapy screening

Inflammation screening

Sources

Other tests: Gut