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Inflammatory bowel disease is considered a condition of chronic inflammation. Ulcerative colitis and Crohn’s disease both exhibit large numbers of leukocytes that migrate to the mucosa and into the intestinal lumen. Endoscopic examination may be used to identify inflamed intestinal mucosa in patients with IBD.1 During the diagnosis of IBD, efforts must be made to rule out other more common etiologies such as infectious colitis (e.g., those caused by Shigella, Campylobacter, and Clostridium difficile).2,3 Patients with active IBD but exhibiting mild signs and symptoms may be difficult to distinguish from patients with active IBS. Unlike IBD, IBS does not involve intestinal inflammation. In persons with IBS, the intestine appears normal upon endoscopic examination and leukocytes are not present in the mucosa or in fecal specimens.4

Human lactoferrin is an 80 kilodalton glycoprotein. This iron-binding protein is secreted by most mucosal membranes and is a major component of the secondary granules of leukocytes, a primary component of the acute inflammatory response. Other hematopoietic cells such as monocytes and lymphocytes do not contain lactoferrin whereas various bodily secretions contain levels in the mg/mL range. During intestinal inflammation, leukocytes infiltrate the mucosa, increasing the level of fecal lactoferrin.3, 5-10


  1. Fine, K. D., F. Ogunji, J. George, M. Niehaus, and R. Guerrant. 1998. Utility of a rapid fecal latex agglutination test detecting the neutrophil protein lactoferrin, for diagnosing inflammatory causes of chronic diarrhea. Am. J. Gastroenterology. 93:1300-1305.
  2. Everhart, J. E. 1994. Digestive diseases in the United States: epidemiology and impact. U.S. Department of Health and Human Services, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. U.S. Government Printing Office, NIH Publication no. 94-1447.
  3. Riley, L. W. 1995. Acute inflammatory diarrhea. In M. Blaser (ed.), P. Smith, J. Ravdin, H. Greenberg, and R. Guerrant, Infections of the Gastrointestinal Tract. Raven Press, New York, NY.
  4. Camilleri, M. 2001. Management of the irritable bowel syndrome. Gastroenterol.120:652-668.
  5. Harris, J. C., H. L. DuPont, and B. R. Hornick. 1971. Fecal leukocytes in diarrheal illness. Ann. Intern. Med. 76:697-703.
  6. Kayazawa, M., O. Saitoh, K. Kojima, K. Nakagawa, S. Tanaka, K. Tabata, R. Maysuse, K. Uchida, M. Hoshimoto, I. Hirata, and K. Katsu. 2002. Lactoferrin in whole gut lavage fluid as a marker for disease activity in inflammatory bowel disease: Comparison with other neutrophil-derived proteins. Am. J. Gastroenterology. 97:360-369.
  7. Guerrant, R.L., V. Araujo, E. Soares, K. Kotloff, A. Lima, W. Cooper, and A. Lee. 1992. Measurement of fecal lactoferrin as a marker of fecal leukocytes. J. Clin. Microbiol. 30:1238-1242.
  8. Sartor, R. B. 1995. Microbial agents in pathogenesis, differential diagnosis, and complications of inflammatory bowel disease. In M. Blaser (ed.), P. Smith, J. Ravdin, H. Greenberg, and R. Guerrant, Infections of the Gastrointestinal Tract. Raven Press, New York, NY.
  9. Sugi, K., O. Saitoh, I. Hirata, and K. Katsu. 1996. Fecal lactoferrin as a marker for disease activity in inflammatory bowel: comparison with other neutrophil derived proteins. Am. J. Gastroenterology. 91:927-934.
  10. Uchida, K., R. Matsuse, S. Tomita, K. Sugi, O. Saitoh, and S. Ohshiba. 1994. Immunochemical detection of human lactoferrin in feces as a new marker for inflammatory gastrointestinal disorders and colon cancer. Clin. Biochem. 27:259-264.