Gut 58:859-868 doi:10.1136/gut.2008.170019
  • Recent advances in clinical practice

Monitoring disease activity by stool analyses: from occult blood to molecular markers of intestinal inflammation and damage

  1. D Foell1,
  2. H Wittkowski1,
  3. J Roth2
  1. 1
    Department of Pediatrics, University of Muenster, Germany
  2. 2
    Institute of Immunology, University of Muenster, Germany
  1. Dr D Foell, Department of Pediatrics, University of Muenster, Albert-Schweitzer-Str 33, D-48149 Muenster, Germany; dfoell{at}
  • Revised 10 December 2008
  • Accepted 15 December 2008
  • Published Online First 9 January 2009


It is a common experience that gastrointestinal symptoms urge us to differentiate inflammatory bowel disease (IBD) from functional disorders. Furthermore, in patients with proven IBD the disease activity has to be accurately monitored. Faecal markers of neutrophil influx into the mucosa are promising indicators of intestinal inflammation. Some neutrophil-derived proteins may be linked to the pathogenesis of IBD due to their functions as damage-associated molecular pattern molecules (DAMPs). Phagocyte-specific DAMPs of the S100 family are released from neutrophils or monocytes, followed by pro-inflammatory activation of pattern recognition receptors. The complex of S100A8/S100A9 was termed “calprotectin” and has been in use as a faecal marker for 10 years. More recently, faecal S100A12 has been reported to be an even more accurate faecal marker of inflammation. We review the biology of this novel group of molecules which can be used as surrogate markers directly linked to the molecular mechanisms of gut inflammation.


  • Competing interests: None.

  • Funding: This work was supported by grants from the Broad Medical Research Program (IBD-0201R) and the Crohn’s and Colitis Foundation of America (Ref# 1911).