When you have bloody or watery diarrhoea, abdominal cramps, with or without fever, lasting more than a few days
A stool sample collected in a clean container
Lactoferrin is a protein released by a type of white blood cell called a neutrophil. When there is inflammation in the gastrointestinal tract, neutrophils are attracted to the area and release lactoferrin, increasing the amount of the protein in the stool. This test measures the amount of lactoferrin in the stool as a way to detect inflammation in the intestines.
Intestinal inflammation is associated with inflammatory bowel disease (IBD) and with some bacterial infections of the gastrointestinal tract, but it is not associated with many other disorders that affect bowel function and cause similar symptoms. Lactoferrin can be used to help distinguish between inflammatory and non-inflammatory conditions.
IBD, a group of chronic disorders that includes both ulcerative colitis (UC) and Crohn’s disease (CD), is characterised by swollen and damaged tissues in the lining of the intestinal tract. Those affected typically have flare-ups of active disease that alternate with periods of remission. Lactoferrin testing can be useful in monitoring disease activity.
How is the sample collected for testing?
A stool sample should be collected into a clean container provided by the laboratory. This sample should not be contaminated by urine or water.
Is any test preparation needed to ensure the quality of the sample?
No test preparation is needed.
How is it used?
Lactoferrin is a stool (faecal) test that is used to detect inflammation in the intestines. Intestinal inflammation is associated with, for example, some bacterial infections and, in people with inflammatory bowel disease (IBD), it is associated with disease activity and severity. The test may be requested to distinguish between IBD and non-inflammatory disorders and to monitor IBD disease activity.
A doctor may request a lactoferrin test to help investigate the cause of a person's persistent watery or bloody diarrhoea. The test may be requested along with other stool tests, such as a stool culture to detect a bacterial infection, and a stool white blood cell test.. If a doctor suspects inflammation, then blood tests that detect inflammation in the body, such as an ESR (erythrocyte sedimentation rate) and/or CRP (C-reactive protein) may also be requested. Testing is performed both to help determine what is causing a person's symptoms and to rule out conditions with similar symptoms. This means that additional blood and stool testing may be performed depending on the suspected causes.
If a person has been diagnosed with IBD, then a lactoferrin test may be requested to monitor disease activity and to help evaluate its severity. For example, if a person has a moderately elevated lactoferrin, then testing may be repeated several weeks later to see if it has stayed moderately elevated, increased, or returned to normal.
A lactoferrin test may be requested to help determine whether an endoscopy is indicated if IBD is suspected. A diagnosis of IBD is usually confirmed by performing an endoscopy (colonoscopy or sigmoidoscopy) to examine the intestines and by obtaining a small tissue sample (biopsy) to evaluate for inflammation and changes in tissue structures. This testing is invasive and is less likely to be necessary if inflammation is not present.
When is it requested?
A lactoferrin test may be requested when a person has symptoms that suggest that intestinal inflammation may be present and when a doctor wants to distinguish between IBD and a non-inflammatory bowel condition.
Symptoms of intestinal inflammation will vary from person to person and over time. They may include one or more of the following:
- Bloody or watery diarrhoea
- Abdominal cramps or pain
- Weight loss
- Rectal bleeding
Testing for lactoferrin may be performed when a doctor wants to determine whether an endoscopy (colonoscopy or sigmoidoscopy) is likely or less likely to be necessary.
When a person has been diagnosed with IBD, a lactoferrin test may be requested whenever a flare-up is suspected, both to confirm disease activity and to evaluate its severity.
What does the test result mean?
An elevated lactoferrin result indicates that inflammation is likely present and active in the gastrointestinal tract but does not indicate either its location or cause. In general, the degree of elevation is associated with the severity of the inflammation. An endoscopy (colonoscopy or sigmoidoscopy) may be indicated as a follow-up test.
In newly diagnosed people with IBD, concentrations of lactoferrin may be very high.
A low concentration of lactoferrin in a stool sample means that a bowel disorder is likely to be non-inflammatory. Examples of non-inflammatory bowel conditions include IBS (irritable bowel syndrome) and diarrhoea due to viral gastrointestinal infections. People with low lactoferrin results are less likely to require an endoscopy.
A moderate lactoferrin result may be seen in individuals with less active IBD. The result indicates that there is likely some inflammation present. If a repeat test shows that the lactoferrin has increased, then the person's condition may be worsening.
Is there anything else I should know?
Lactoferrin is related to another stool test, calprotectin. Both are substances that are released by WBCs in the stool and are associated with intestinal inflammation. The clinical use of these tests is still relatively new. They are promising as non-invasive ways of evaluating intestinal inflammation and are potentially more sensitive than stool white blood cell testing, but they are not yet available in all laboratories. Of the two tests, calprotectin has been the most extensively studied and it is requested more frequently than lactoferrin. Usually one or the other may be requested but not both. Lactoferrin testing is not routinely available in UK laboratories.
A baby that is being breast-fed could potentially have a false-positive result because of lactoferrin present in the mother's breast milk.
Should both a lactoferrin and a calprotectin test be done?
Current evidence suggests that there is not a significant benefit to performing both tests as they both detect intestinal inflammation.
Does it matter whether I have a lactoferrin or a calprotectin test?
Calprotectin has been more extensively studied and is requested more frequently, but in general they are both thought to be useful tests.
What can I do to decrease my lactoferrin?
Lactoferrin is a reflection of intestinal inflammation and is not affected by lifestyle changes. If it is due to an infection, then it will most likely return to normal when the infection resolves. If it is due to inflammatory bowel disease, then it will rise and fall with disease activity.
Can the lactoferrin test be performed in my doctor's surgery?
No. This test is somewhat specialised and is not offered by all laboratories. The sample will likely be sent to a reference laboratory (providing specialist analysis and interpretation) for testing and it may take several days before results are available.
On This Site
Tests: Calprotectin, Faecal Occult Blood Test and Faecal Immunochemical Test, Stool Culture, White Blood Cell, Clostridium difficile and C. difficile Toxin Testing, ESR, C-Reactive Protein, OCP
Conditions: Inflammatory Bowel Disease, Diarrhoea