Diagnosis of Inflammatory Bowel Disease

Abstract

Research Article| December 01 2017 Diagnosis of Inflammatory Bowel Disease AAP Grand Rounds (2017) 38 (6): 64. https://doi.org/10.1542/gr.38-6-64 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Diagnosis of Inflammatory Bowel Disease. AAP Grand Rounds December 2017; 38 (6): 64. https://doi.org/10.1542/gr.38-6-64 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: inflammatory bowel disease, leukocyte l1 antigen complex, irritable bowel syndrome, feces Source: Holtman GA, Lisman-van Leeuwen Y, Day AS, et al. Use of laboratory markers in addition to symptoms for diagnosis of inflammatory bowel disease in children: a meta-analysis of individual patient data. JAMA Pediatr. [published online ahead of print 2017 August 14]; doi: https://doi.org/10.1001/jamapediatrics.2017.1736 An international group of investigators from multiple institutions conducted a meta-analysis augmented with individual patient data (IPD) to assess whether selected blood markers and fecal calprotectin increase the accuracy of diagnosis of inflammatory bowel disease (IBD) in children. The investigators identified published diagnostic studies of pediatric patients (≤18 years old) referred for evaluation for possible IBD that included results of ≥1 laboratory test. The diagnosis of IBD in the included studies was based on histopathologic analysis of endoscopic biopsies or absence of symptoms at clinical follow-up (for a diagnosis of no IBD). The authors of included studies were contacted and asked to provide IPD that included final diagnosis (IBD or no IBD), information about symptoms, and levels from specific laboratory tests (C-reactive protein [CRP] level, erythrocyte sedimentation rate [ESR], platelet count, albumin level, hemoglobin level, and fecal calprotectin level). By using the collected IPD, a logistic regression model that includes presence or absence of the symptoms of abdominal pain, diarrhea, and rectal bleeding was constructed, and the accuracy of these symptoms for diagnosis of IBD was assessed by calculating the area under the receiver operating characteristic curve (AUC). The increased accuracy achieved with the laboratory tests was assessed by measuring the change in AUC in the model after adding the levels for each individual test. In addition, the discriminatory value of each laboratory test alone in pediatric patients with suspected IBD was calculated. Of 16 identified studies, the authors of 8 provided IPD that were used for analysis. These 8 studies included information on 1,120 patients, of whom 560 had IBD; the median prevalence of IBD across the 8 studies was 43% (range, 19%–62%). The AUC of the laboratory markers alone included ESR of 0.84, albumin level of 0.82, CRP level of 0.79, platelet count of 0.79, hemoglobin level of 0.76, and fecal calprotectin level of 0.95. The AUC of the symptoms model was 0.70; adding any of the laboratory markers significantly increased the accuracy of diagnosis. The addition of fecal calprotectin improved the AUC of the symptom model the most out of any marker (ΔAUC, 0.26), followed by ESR (ΔAUC, 0.16). The authors conclude that laboratory markers improve the accuracy of diagnosis of IBD in children with chronic gastrointestinal symptoms. Of the specific laboratory markers assessed, fecal calprotectin increased the diagnostic accuracy the most. Dr Rosenthal has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. Discriminating between children with and those without IBD is often difficult.1 Functional gastrointestinal disorders, such as irritable bowel syndrome, may mimic IBD. Although history and physical examination findings may suggest IBD, endoscopy–an inherently invasive procedure–remains the cornerstone of... You do not currently have access to this content.