Technology Insight: calprotectin, lactoferrin and nitric oxide as novel markers of inflammatory bowel disease

Distinguishing patients with inflammatory bowel disease (IBD) from those with irritable bowel syndrome can be difficult, and a simple and reliable test that detects intestinal inflammation would be very useful in the clinic. This Review discusses the formation, measurement and intended clinical use of three novel markers of IBD—fecal calprotectin, fecal lactoferrin and luminal nitric oxide. Distinguishing patients with inflammatory bowel disease from those with irritable bowel syndrome can be difficult. A simple and reliable test that detects intestinal inflammation would therefore be very useful in the clinic. If such a test parameter correlated with the intensity of the inflammatory reaction it could also be used to monitor disease activity. Calprotectin, lactoferrin and nitric oxide are produced and released locally in much greater quantities in the inflamed gut than in the noninflamed gut. These compounds can be readily measured in fecal samples (calprotectin and lactoferrin) or directly in the intestinal lumen (nitric oxide gas). Here, we discuss what is known about these markers, how they could be used in clinical practice and how they can complement existing techniques used for the diagnosis and monitoring of inflammatory bowel disease.