Faecal calprotectin rises with any neutrophilic inflammation in the gut, not only inflammatory bowel disease. Infection, colorectal cancer and polyps can raise it, and so can non-steroidal anti-inflammatory drugs and proton pump inhibitors, both widely used.
A mildly raised result in a patient on either drug, or after a recent gastroenteritis, is often best repeated after a few weeks, with the drug stopped if possible. A clearly high or persistent value with symptoms needs endoscopic assessment.
- Ask about NSAID and proton pump inhibitor use before interpreting a calprotectin result.
- Repeat a mildly raised result after a few weeks, off NSAIDs where possible.
- Avoid testing during or just after an acute gastroenteritis.
- Refer for endoscopy when calprotectin is clearly high or persistently raised with symptoms.
Why it matters
A single raised calprotectin can trigger an unnecessary colonoscopy or a wrong label.
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