Abstract
Background. Optimal management of pediatric patients with inflammatory bowel disease (IBD) requires early diagnosis. Aim of the study is to compare fecal lactoferrin (FL) as biomarker of intestinal inflammation to CRP in pediatric patients with new-onset IBD. Methods. FL was measured by ELISA in stool specimens collected prior to endoscopy for IBD (IBD-SCAN; TechLab, Blacksburg; normal < 7.3 µg/g feces). CRP was detected in serum (normal < 5 mg/L). Three patient groups were determined: n = 21 (mean age 13.2) with Crohn's disease (CD), n = 15 (mean age 10.9) with ulcerative colitis (UC), and n = 20 (mean age 11.9) in whom IBD was ruled out. In CD patients the endoscopic severity score SES-CD was correlated with the FL levels. Results. (Mean ± SEM). CRP levels were 27.18 ± 4.2 for CD-cases, 20.8 ± 9.5 for UC, and 0.24 ± 0.06 for non-IBD patients. FL levels were 313.6 ± 46.4 in CD, 370.7 ± 46.9 in UC, and 1.3 ± 0.5 in non-IBD patients. Sensitivity of CRP to detect IBD was 75% with specificity of 100%, positive predictive value of 100%, and negative predictive value of 69%. Sensitivity of FL was 100% with specificity of 95%, positive predictive value of 97.3%, and negative predictive value of 100%. In CD, FL levels correlated positively (R 2 = 0.42) with disease severity as judged by the SES-CD. Conclusions. Elevated FL corresponds to intestinal inflammation, even in patients with normal CRP. With high probability, normal FL excludes intestinal inflammation.
Highlights
Optimal management of pediatric patients with inflammatory bowel disease (IBD) requires early diagnosis
Upper and lower endoscopy and the histology of both examinations were normal with no signs typical for IBD
We have clearly shown in a relatively large control group with symptoms severe enough to justify endoscopy that normal fecal lactoferrin (FL) excludes intestinal inflammation caused by IBD with high probability (P < 0.0001)
Summary
Inflammatory bowel disease (IBD) involves a large clinical spectrum of disease presentations from mild to severe symptoms in relation to different disease locations and the extent from possible rectal to upper intestinal involvement. Recent studies have shown fecal lactoferrin (FL) as a sensitive biomarker for pediatric IBD [8, 9]. This biomarker can serve as an aid for guiding the diagnostic and therapeutic process for both pediatric and adult IBD [10,11,12]. We evaluated the utility of FL compared to CRP [13, 14] for diagnosing pediatric IBD characterized by endoscopic and histologic examination. We analysed FL in comparison to the disease severity in CD as defined by the endoscopic score SES-CD [15]
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