Mo1989 Serum D-Lactate: A Novel Biomarker for Severe Small Bowel Bacterial Overgrowth in Children With Intestinal Failure

Abstract

was to evaluate the clinical outcomes, particularly with regards to IBD, in children presenting with abdominal pain who have findings of thickened bowel wall on CT scan. METHODS: A retrospective analysis of pediatric patients at two large military medical centers with CT findings of thickened bowel wall was performed between January 2007 and April 2011. Patients with no known underlying disease, presenting with abdominal pain in the outpatient setting were included. Endoscopic findings and their clinical variables, as well as follow up assessments in those who did not undergo endoscopy, were evaluated. RESULTS: 56 patients (mean age 13.7 years) presenting with abdominal pain in the outpatient setting who had thickened bowel wall findings on CT scan were identified. 27% had isolated TI thickening, 23% had both TI and colonic thickening, while 29% had colonic involvement only. Of the 56 patients, 20 (36%) underwent endoscopic evaluation. 11 of those 20 (55%) were ultimately diagnosed with IBD based on histology and their clinical picture. The lab variables that most strongly predicted IBD in these patients included ESR>22 (100% had IBD), CRP>1.5 (100%), albumin 320 (82%), and hemoglobin (hgb)<12 (62%). Of the remaining patients who did not undergo endoscopy, 25% had appendicitis, 27% had infectious gastroenteritis and 22% were diagnosed with functional pain. Additional follow up of these patients for an average of 22 months beyond the original CT scan revealed no new diagnoses of IBD. CONCLUSIONS: The presence of thickened bowel wall on CT scans is a non-specific finding in children. Ultimately, 20% of our patients were diagnosed with IBD, suggesting that urgent subspecialty evaluation may not always be warranted. However, laboratory screening with ESR, CRP, albumin, platelets, and hgb, utilizing the cutoff values described, would have accurately separated most of our patients with IBD. The use of these screening tests on patients noted to have bowel wall thickening may help distinguish which patients require additional evaluation and endoscopy.