Original Contribution | Published:

Fecal Lactoferrin Is a Sensitive and Specific Marker in Identifying Intestinal Inflammation

American Journal of Gastroenterology volume 98, pages 13091314 (2003) | Download Citation

Subjects

Abstract

OBJECTIVE:

Lactoferrin is a glycoprotein expressed by activated neutrophils. The aim of this study was to determine the sensitivity and specificity of fecal lactoferrin concentrations for inflammatory bowel disease (IBD) or irritable bowel syndrome (IBS) versus healthy controls.

METHODS:

Fresh stool samples were collected from outpatients with ulcerative colitis (UC), Crohn's disease (CD), or IBS. Clinical disease activity for IBD was assessed using a modified Harvey–Bradshaw Activity Index. Fecal lactoferrin concentrations were determined using a polyclonal antibody-based enzyme linked immunoassay. Mean fecal lactoferrin concentrations for each group and sensitivity and specificity of the assay were determined.

RESULTS:

One hundred-four CD patients, 80 UC patients, 31 IBS patients, and 56 healthy controls were recruited. The mean ± SE fecal lactoferrin concentration (μg/g fecal weight) was 440 ± 128 for CD patients, 1125 ± 498 for UC patients, 1.27 ± 0.29 for IBS patients, and 1.45 ± 0.4 for healthy controls. Fecal lactoferrin was 90% specific for identifying inflammation in patients with active IBD. Elevated fecal lactoferrin was 100% specific in ruling out IBS.

CONCLUSIONS:

Fecal lactoferrin is sensitive and specific for detecting inflammation in chronic IBD. This noninvasive test may prove useful in screening for inflammation in patients presenting with abdominal pain and diarrhea.

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Acknowledgements

We are grateful to Virginia Polytechnic Institute and State University, Department of Statistics, for providing an independent data analysis.

Author information

Affiliations

  1. University of Chicago, Chicago, Illinois, USA

    • Sunanda V Kane
    •  & Michael Camilleri
  2. Mayo Clinic, Rochester, Minnesota, USA

    • William J Sandborn
  3. Children's Hospital, Boston Massachusetts, USA

    • Paul A Rufo
    •  & Anna Zholudev
  4. TechLab, Blacksburg, Virginia, USA

    • James Boone
    • , David Lyerly
    •  & Stephen B Hanauer

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Corresponding author

Correspondence to Sunanda V Kane.

Appendices

Appendix A

Harvey–Bradshaw Activity Index for CD

  • 1) No. liquid or very soft stools per day: _____

  • 2) Abdominal pain, sum of seven daily ratings: _____ (0 = none, 1 = mild, 2 = moderate, 3 = severe)

  • 3) General well-being:_____   (0 = very well, 1 = slightly below par, 2 = poor, 3 = very poor, 4 = terrible)

  • 4) Complications: (score 1 point per item) Arthritis or arthralgia     _____ Skin or mouth lesions     _____ Iritis or uveitis     _____ Anal fissure, fistula, or perianal abscess _____

  • 5) Abdominal mass: _____ (0 = none, 1 = questionable, 2 = definite, 3 = definite and tender on examination)

Score: _____ Patient Initials: _____

Harvey–Bradshaw Activity Index for UC

  • 1) No. liquid or very soft stools per day: _____

  • 2) Abdominal pain, sum of seven daily ratings: _____ (0 = none, 1 = mild, 2 = moderate, 3 = severe)

  • 3) General well-being: _____ (0 = very well, 1 = slightly below par, 2 = poor, 3 = very poor, 4 = terrible)

  • 4) Complications: (score 1 point per item) _____  Arthritis or arthralgia      _____  Skin or mouth lesions      _____  Iritis or uveitis      _____  Anal fissure, fistula, or perianal abscess _____

  • 5) Bleeding per rectum: _____ (0 = none, 1 = slight, 2 = moderate, 3 = severe)

Score: _____ Patient Initials: _____

Appendix B

IBS Symptom Questionnaire

Please rate the following symptoms on a scale of 0–10, with 0 = no symptoms and 10 = severe.

Nausea     _____

Bloating     _____

Abdominal pain     _____

Diarrhea     _____

Constipation     _____

Anorexia     _____

Score: _____ Patient Initials: _____

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DOI

https://doi.org/10.1111/j.1572-0241.2003.07458.x

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