I have a patient with very high calprotectin levels on a previous stool test about 200, as well as high secretory IgA, but a normal lactoferrin. Giardia was also found. In this situation, would you assume the high inflammatory markers were due to a parasite? Or would you still consider referral for a colonoscopy?

Dr. Amy Nett: I don’t know that we can make the assumption. I think it’s certainly likely that the GI inflammation is due to the giardia, but we don’t know, so what I would do is I would treat the giardia and then repeat the stool test. Once you’ve confirmed that giardia has been successfully treated, then you can repeat the lysozyme, lactoferrin, and calprotectin. You might do the whole CSAPx3 to see what else could be contributing to the GI inflammation, see if there’s something else that needs to be tweaked. If the makeup of the gut microbiome looks normal, you’re seeing yeast overgrowth, you’re not seeing any residual parasites, and there’s still an elevation in calprotectin, then I would probably run an IBD panel and probably consider a referral to a gastroenterologist at that time. I think until you treat the giardia there’s not a good way of knowing what’s causing the inflammation.