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World J Gastroenterol. Jan 14, 2014; 20(2): 363-375
Published online Jan 14, 2014. doi: 10.3748/wjg.v20.i2.363
Diagnostic utility of faecal biomarkers in patients with irritable bowel syndrome
Jan Däbritz, Jason Musci, Dirk Foell
Jan Däbritz, Gastrointestinal Research in Inflammation and Pathology, Murdoch Children’s Research Institute, The Royal Children’s Hospital Melbourne, Parkville 3052, VIC, Australia
Jan Däbritz, Jason Musci, Department of Paediatrics, Melbourne Medical School, University of Melbourne, Parkville 3052, VIC, Australia
Jan Däbritz, Dirk Foell, Department of Paediatric Rheumatology and Immunology, University Children’s Hospital Münster, 48149 Münster, Germany
Author contributions: Däbritz J and Musci J contributed equally to this work; Däbritz J, Musci J and Foell D analysed and interpreted data; Däbritz J created tables and figures; Däbritz J and Musci J wrote the paper; Foell D critically reviewed and submitted the manuscript; Däbritz J, Musci J and Foell D read and approved the final version of the manuscript.
Supported by A research fellowship awarded to Däbritz J by the German Research Foundation, No. DFG DA1161/5-1
Correspondence to: Dirk Foell, MD, Professor, Director, Department of Paediatric Rheumatology and Immunology, University Children’s Hospital Münster, Röntgenstr. 21, 48149 Münster, Germany.
Telephone: +49-251-8358178 Fax: +49-251-8358104
Received: September 9, 2013
Revised: November 12, 2013
Accepted: November 28, 2013
Published online: January 14, 2014

Irritable bowel syndrome (IBS) is a common functional gastrointestinal (GI) disorder characterized by unspecific symptoms. In clinical practice it is crucial to distinguish between non-inflammatory functional problems and inflammatory, malignant or infectious diseases of the GI tract. Differentiation between these involves the use of clinical, radiological, endoscopic, histological and serological techniques, which are invasive, expensive, time-consuming and/or hindered by inaccuracies arising from subjective components. A range of faecal markers now appears to have the potential to greatly assist in the differentiation of inflammatory bowel disease (IBD) and IBS. Faecal markers of neutrophil influx into the mucosa are reliable indicators of intestinal inflammation and their role has been mainly studied in discriminating IBD from non-IBD conditions (including IBS) rather than organic from non-organic diseases. Phagocyte-specific proteins of the S100 family (S100A12, calprotectin) are amongst the most promising faecal biomarkers of inflammation. Faecal leukocyte degranulation markers (lactoferrin, polymorphonuclear elastase and myeloperoxidase) have also been suggested as diagnostic tools for the differentiation of IBD and IBS. More recently, additional proteins, including granins, defensins and matrix-metalloproteases, have been discussed as differential diagnostic markers in IBD and IBS. In this review, some of the most promising faecal markers, which have the potential to differentiate IBD and IBS and to advance diagnostic practices, will be discussed.

Keywords: S100A12, Calprotectin, Lactoferrin, M2-pyruvate kinase, Polymorphonuclear elastase, Defensins, Granins, Irritable bowel syndrome

Core tip: Faecal markers of intestinal inflammation represent a practicable, non-invasive, inexpensive and objective diagnostic tool to differentiate organic [inflammatory bowel disease (IBD)] and functional [irritable bowel syndrome (IBS)] gastrointestinal diseases. Faecal markers have the potential to be incorporated into standard clinical practice for the routine assessment of IBS and IBD. Neutrophil-derived faecal biomarkers show a high diagnostic accuracy in the differentiation of IBD vs IBS. They can provide reassurance to the physicians that the clinical diagnosis of IBS is correct. Future progress in our knowledge about the biology of these proteins and the underlying pathogenesis of IBS will help translate IBD/IBS research into patient care.