Treatment for Elevated Fecal Calprotectin Levels

Assessment and Treatment Approach

The American Gastroenterological Association recommends that treatment for elevated fecal calprotectin should be guided by the severity of symptoms and the degree of elevation, with endoscopic assessment recommended for mild symptoms and empiric treatment adjustment for moderate to severe symptoms with levels >150 μg/g 1, 2, 3
Fecal calprotectin >150 μg/g indicates active intestinal inflammation, particularly in inflammatory bowel disease (IBD), with a treatment approach that differs based on symptom severity and calprotectin levels 1, 2, 3, 4

For patients with moderate to severe symptoms and calprotectin >150 μg/g, the European Crohn’s and Colitis Organisation suggests initiating or adjusting treatment without requiring endoscopic assessment, considering appropriate IBD therapy based on disease type and severity 1, 3, 5
For patients with mild symptoms and calprotectin >150 μg/g, endoscopic assessment is recommended before treatment adjustment, as suggested by the American College of Gastroenterology 2, 7

Repeat fecal calprotectin measurement is recommended 2-4 months after initiating or adjusting therapy to monitor response, as advised by the American Gastroenterological Association 6
The American College of Gastroenterology recommends considering endoscopic assessment 6-12 months after treatment initiation to confirm mucosal healing 10, 6
For patients in symptomatic remission with calprotectin <150 μg/g, no intervention is needed, indicating absence of active inflammation, as stated by the European Crohn’s and Colitis Organisation 9, 8