What does the presence of lactoferrin in stool indicate and how is it treated?

From the Guidelines

The presence of lactoferrin in stool indicates intestinal inflammation, which can be associated with inflammatory bowel disease (IBD) or infectious causes, and its detection is crucial for guiding treatment decisions, as suggested by the most recent study 1.

Key Points

• Lactoferrin is a biomarker for intestinal inflammation, with a sensitivity of 83% and specificity of 75% for detecting moderate to severe endoscopic inflammation, as reported in the 2023 study 1.
• The presence of lactoferrin in stool can be due to various causes, including IBD, such as Crohn's disease or ulcerative colitis, or infectious causes like bacterial gastroenteritis.
• Treatment depends on the underlying cause, with anti-inflammatory medications, immunomodulators, or biologics used for IBD, and antibiotics for infectious causes.
• Supportive care, including hydration, rest, and dietary modifications, is essential in all cases.

Diagnostic Approach

• Further diagnostic tests, such as stool cultures, colonoscopy, or imaging studies, are typically needed to determine the specific cause of inflammation before initiating targeted treatment.
• Fecal lactoferrin can be used as a non-invasive test to monitor disease activity and response to treatment, as suggested by the 2023 AGA clinical practice guideline 1.

Treatment Considerations

• The treatment course varies from short-term for infections to long-term management for chronic inflammatory conditions.
• Lactoferrin levels can help clinicians monitor treatment response and adjust treatment plans accordingly.
• A biomarker-based monitoring strategy, including fecal lactoferrin, may be useful in patients with UC, especially those with mild symptoms or in symptomatic remission, as recommended by the 2023 AGA guideline 1.

From the Research

Presence of Lactoferrin in Stool

• The presence of lactoferrin in stool is an indicator of intestinal inflammation, which can be associated with inflammatory bowel disease (IBD) such as ulcerative colitis (UC) and Crohn's disease (CD) 2, 3, 4.
• Lactoferrin is a sensitive and specific marker of disease activity in patients with IBD, and its levels correlate well with clinical disease activity indices and laboratory measures of inflammation 2, 3, 4.
• Elevated levels of lactoferrin in stool can distinguish between inflammatory and non-inflammatory bowel disease, and can be used to rule out irritable bowel syndrome (IBS) 3, 4.

Treatment and Management

• The treatment and management of IBD and intestinal inflammation involve a range of approaches, including medication, dietary changes, and surgery 5, 6.
• Fecal markers such as lactoferrin and calprotectin can be used to monitor disease activity and response to treatment, and can help guide management decisions 5.
• Lactoferrin has been shown to have anti-inflammatory and immune-modulating effects, and may have a potential role in the prevention and treatment of IBD 6.

Diagnostic Accuracy

• The diagnostic accuracy of lactoferrin in detecting IBD is high, with sensitivity and specificity ranging from 80-100% 3, 4, 5.
• Lactoferrin can be used in combination with other markers and clinical assessments to diagnose and manage IBD 5.
• Elevated levels of lactoferrin can indicate a higher risk of postoperative recurrence and pouchitis in patients with IBD 5.