Add-On: Fecal Lactoferrin
The fecal lactoferrin test measures a neutrophil-derived glycoprotein in stool that signals active intestinal mucosal inflammation. It distinguishes inflammatory bowel disease from functional disorders, monitors disease activity in established IBD, and triages patients for endoscopy. Its shorter stability compared to calprotectin makes specimen handling critical.
1
Biomarkers
Stool
Sample
5–7 business days
Turnaround
No
Fasting
What is the Fecal Lactoferrin test?
The Fecal Lactoferrin test quantifies a neutrophil-derived protein in stool to detect and monitor active intestinal inflammation. It is ordered as an add-on to comprehensive stool panels or as a standalone marker when practitioners need to differentiate organic inflammatory disease from functional bowel symptoms without resorting to endoscopy at the outset. Lactoferrin is released by neutrophils that have migrated across an inflamed intestinal mucosa, so its presence in faecal matter reflects active mucosal injury rather than systemic or remote inflammation. Practitioners use this test to support or refute a working diagnosis of inflammatory bowel disease, to assess disease activity in patients already known to have Crohn's disease or ulcerative colitis, and to determine whether symptoms warrant invasive investigation or can be managed conservatively.
What does the Fecal Lactoferrin test measure?
Lactoferrin is an iron-binding glycoprotein synthesised and released by activated neutrophils. Under normal circumstances, lactoferrin is largely absent from stool because intact intestinal mucosa does not permit significant neutrophil migration into the lumen. When inflammatory conditions breach the mucosal barrier, neutrophils migrate into the intestinal lumen and degranulate, releasing lactoferrin into faecal matter. Unlike calprotectin, lactoferrin degrades more rapidly in the presence of endogenous proteases, making it a marker of active, proximate inflammation rather than cumulative or remote neutrophil activity.
Fecal lactoferrin serves as a non-invasive indicator of active intestinal neutrophil infiltration and mucosal inflammation. It is particularly useful for distinguishing inflammatory bowel disease from functional gastrointestinal disorders, monitoring disease activity in established IBD, and triaging patients for invasive endoscopy. Its shorter half-life in stool compared to calprotectin means that lactoferrin may be more responsive to acute changes in inflammation, though this same property can also make it more vulnerable to pre-analytical degradation.
Why is the Fecal Lactoferrin test ordered?
- Differentiation of inflammatory bowel disease from irritable bowel syndrome or other functional gastrointestinal disorders in patients with chronic diarrhoea, abdominal pain, or blood in stool
- Non-invasive monitoring of mucosal inflammation and treatment response in patients with established Crohn's disease or ulcerative colitis
- Triage and risk stratification before endoscopy — a negative result may defer or obviate colonoscopy in low-risk patients, while a positive result strengthens the indication
- Investigation of unexplained chronic diarrhoea when infectious causes have been excluded and inflammatory colitis remains in the differential
- Assessment of post-operative recurrence in Crohn's disease, where rising lactoferrin may signal mucosal relapse before overt symptoms develop
- Paediatric gastroenterology, where non-invasive inflammatory markers help guide the decision to proceed to endoscopy in children with suspected IBD
Sample collection and turnaround
Sample type
Stool
Fasting required
No
Collection method
At-home collection kit
Turnaround
5–7 business days
Collection notes
Patient collects a small stool sample using the supplied container and preservative vial or frozen transport medium. The specimen must be frozen at home within a few hours of passage and shipped on dry ice or cold packs to Genova to preserve lactoferrin stability. Detailed collection and shipping instructions are provided with the kit.
Specimen requirements
Approximately 2–5 g stool in the supplied collection device. Freeze promptly and maintain frozen during transit. Avoid collection during menstruation or if gross blood contamination is present, as these may interfere with interpretation. Note the collection date and any recent medications (especially NSAIDs and antibiotics).
What can affect Fecal Lactoferrin results?
NSAIDs can cause small and large bowel ulceration and neutrophil infiltration independent of IBD, so a medication history is essential to interpretation.
Bacterial, viral, or protozoal enteritis provokes neutrophil migration and lactoferrin release; infection must be excluded or treated before attributing an elevated result to chronic inflammatory disease.
Lactoferrin is susceptible to proteolytic degradation by faecal enzymes; specimens should be frozen promptly after collection to preserve analyte stability, and suboptimal handling may yield false-negative results.
Lactoferrin may be degraded or diluted during transit through the distal bowel, so proximal Crohn's disease can produce less faecal lactoferrin than colonic disease despite equivalent inflammatory activity.
Dilution or accelerated transit may reduce the measured concentration; ideally the specimen is collected after normal bowel habits have resumed.
What do Fecal Lactoferrin results mean?
Elevated
Active intestinal inflammation with neutrophil infiltration — inflammatory bowel disease (Crohn's disease, ulcerative colitis), infectious colitis or enteritis, NSAID enteropathy, ischaemic colitis, or other inflammatory mucosal injury. Values substantially above the threshold correlate with more severe endoscopic and histological inflammation.
Normal
A normal fecal lactoferrin makes significant active inflammatory bowel disease unlikely and supports a functional or non-inflammatory diagnosis. It does not exclude quiescent IBD, early or patchy disease, or conditions that do not trigger neutrophil migration.
Reduced
Below the detection threshold or reference cut-off is normal and consistent with an intact intestinal mucosa. However, a falsely low result can occur if the specimen was delayed, inadequately frozen, or if inflammation is proximal and lactoferrin has been degraded during transit.
Note: Lactoferrin is method-specific and more labile than calprotectin; specimen handling is critical. A single normal result does not exclude IBD if clinical suspicion is high, and serial testing or correlation with calprotectin and clinical indices improves diagnostic confidence. Positive results require correlation with history, stool culture, and — when indicated — endoscopy.
Frequently asked questions
Both detect neutrophil-driven intestinal inflammation, but lactoferrin is more labile and degrades faster in stool, potentially reflecting more acute inflammation. Calprotectin is more stable, widely adopted, and better validated for serial monitoring, though lactoferrin may be more responsive to short-term changes.
How to access the Fecal Lactoferrin test
The Fecal Lactoferrin reference page is free and open to all practitioners. Create a free practitioner account to see pricing, save tests to your list, and generate requisition forms. Verification takes 1–2 business days.
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Published: October 7, 2026
Last reviewed: October 7, 2026
- Lamb CA, et al. British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults. Gut. (2019)
- van Rheenen PF, et al. Faecal calprotectin for screening of patients with suspected inflammatory bowel disease: diagnostic meta-analysis. BMJ. (2010)
- Tibble JA, et al. Use of surrogate markers of inflammation and Rome criteria to distinguish organic from nonorganic intestinal disease. Gastroenterology. (2002)
- Kane SV, et al. Fecal lactoferrin is a sensitive and specific marker in identifying intestinal inflammation. Am J Gastroenterol. (2003)
- Kok L, et al. Diagnostic accuracy of point-of-care fecal calprotectin and immunochemical occult blood tests for diagnosis of organic bowel disease in primary care. Clin Gastroenterol Hepatol. (2012)
This content is for licensed healthcare practitioners only and does not constitute medical advice. Clinical decisions should be based on the full clinical picture and not on any single test result.