A non-invasive laboratory test, called Fecal Calprotectin, is readily available as a helpful diagnostic tool to monitor individuals with inflammatory bowel disease (Crohn’s diseaseulcerative colitis, indeterminate colitis) and to distinguish from irritable bowel syndrome.

Calprotectin is a protein found in human blood, saliva, cerebrospinal fluid, and urine when some part of the body is inflamed, although it is not always possible to tell the location of the inflammation during testing of these fluids. When detected in the stool, calprotectin has a direct relationship (consequence of neutrophil degranulation) to bowel mucosal damage, characteristic of inflammatory bowel disease.

If the test finds a large amount of calprotectin present in the stool, it is more likely that the patient has inflammatory bowel disease (IBD), while if the test comes back with low or normal levels of calprotectin, it points more toward irritable bowel syndrome (IBS), a functional condition of altered bowel habits with no inflammation.

This test is also helpful for individuals already diagnosed with IBD, as it can identify the level of inflammation. If a person diagnosed with IBD subsequently shows low levels of fecal calprotectin, this means that the inflammation is being controlled, so the treatment regime is working. When a person has increased symptoms (flare), a physician might request this test at different intervals to confirm inflammatory disease activity. It is important to remember that you can have inflammation without symptoms and symptoms without inflammation in IBD, so monitoring of an objective marker of disease activity, such as fecal calprotectin, is essential for optimizing treatment outcomes.

Compared to intestinal biopsy, this test is non-invasive, requires no bowel prep, and is effective. While a physician might still suggest colonoscopy and biopsy in some cases, the results of this test helps the physician to understand the effect prescribed medications are having on the IBD patient and, with that information, can adjust treatment without the need for a scope.

This test is costly but the Alberta and Quebec provincial health plans pay for this valuable test, as do  many extended health insurance plans. We hope that other jurisdictions in Canada will also see the benefit of the fecal calprotectin test and provide it for their residents as well.


Different Characteristics of IBS & IBD

Characteristic IBS

Irritable Bowel Syndrome
(defined by symptom criteria)


Inflammatory Bowel Disease
Crohn’s disease/ulcerative colitis

structural change in gut no yes
prevalence 13-20% 0.7%
age all all
gender more common in females about equal
race all all, but more in Jewish
geography worldwide Canada among the highest
seek health care about 30% virtually all
fever, anemia, rectal bleeding, malnutrition no yes
abdominal mass no sometimes
complications in gut, skin, joints, eyes no yes
life expectancy normal almost normal
need for surgery no often
physical disability no often
psychological co-morbidity sometimes sometimes
social inconvenience often frequently

First published in the Inside Tract® newsletter issue 195 – 2015