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Test Indications:

  • Suspected health concerns of a digestive nature
  • Differentiating from Irritable Bowel Syndrome from Inflammatory Bowel Disease
  • Patient has a wide variety of symptoms of unknown etiology

Test Summary:

  • Testing for lactoferrin to confirm inflammatory bowel disease

Inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) are two chronic conditions associated with diarrhea and abdominal pain, and these symptoms are among the most common reasons that patients seek medical advice. Differential diagnosis between IBD and IBS is very important because IBD and IBS have very different underlying pathophysiologies and IBD can become life threatening and possibly require extensive life long treatment and/or surgery.   In contrast, IBS can often be treated with dietary restrictions, stress reduction and is not associated with rectal bleeding.

IBD encompasses Ulcerative Colitis (UC) and Crohn’s Disease (CD), which are inflammatory diseases of the gastrointestinal (GI) tract. UC is isolated almost exclusively in the colon, but CD occurs in various segments of the GI tract; the anatomical location and degree of inflammation determine the predominant symptoms, which may include rectal bleeding. IBS does not involve inflammation or rectal bleeding, and is considered a functional disorder caused by abnormal GI motility, altered pain perception, food sensitivity, or dysbiosis. In the absence of rectal bleeding, clinical differentiation between IBD and IBS has been difficult without invasive endoscopy.

The test is designed to measure the fecal concentration of the inflammatory protein, lactoferrin, which facilitates noninvasive differentiation between IBD and IBS. Fecal lactoferrin, an iron binding glycoprotein derived from polymorphonuclear neutrophils (a type of white blood cell), is elevated with IBD but not IBS. During intestinal inflammation, leukocytes infiltrate the mucosa, which results in increased lactoferrin in the feces.

Kane S, Sandborn W, Rufo P et al. Fecal lactoferrin is a sensitive and specific marker in identifying intestinal inflammation.   Am. J.     Gastroenterol. 2003; 98:1309-14

Sugi K, Saitoh O, Hirato I et al. Fecal lactoferrin as a marker for disease activity in inflammatory bowel disease: A comparison with other neutrophil-derived proteins.   Am. J. Gastroenterol.   1996; 91:927-33

Buderus S, Lohmann N, Lentze M et al. Clinical evaluation of the IBD-CHEK Test for detecting elevated fecal lactoferrin as an indicator of intestinal inflammation in pediatric patients. Suppl. Gastroenterol. 2002; 122:A-219:S1392

Baveye S, Elass, E, Mazurier J et al. Lactoferrine: A multifunctional glycoprotein involved in the modulation of the inflammatory response.   Clin. Lab. Med. 1999;37: 281-286

Fine K, Ogunji F, George J et al.   Utility of a rapid fecal latex agglutinization test detecting the neutrophil protein, lactoferrin, for diagnosing inflammatory causes of chronic diarrhea. Am. J. Gastroenterol. 1993; 93:1300-1305

Walker T, Sandborn W, Boone J et al. Fecal lactoferrin measurements are useful in the interval assessment of patients with active and inactive inflammatory bowel disease.   Am. J. Gastroenterol. 2003; 98: S246:742

Huicho L, Garaycochea V, Uchima N et al. Fecal lactoferrin, fecal leukocytes and occult blood in the diagnostic approach to childhood invasive diarrhea. Ped. Infect. Dis. J. 1997; 16:644-647

Guerrant R, Araujo V, Soares E et al. Measurement of fecal lactoferrin as a marker of fecal leukocytes.   J. Clin. Microbiol. 1992; 30:1238-1242