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Abstract

We hope that the fewest number of children possible who undergo endoscopy are found to have normal macroscopic and microscopic findings. At the same time, we hope that children with inflammatory bowel disease (IBD), such as Crohn’s disease (CD) and ulcerative colitis (UC), are selected to undergo endoscopy and are not overlooked, leading to delayed diagnosis. Blood tests remain the simplest form of testing to guide this decision making, based on availability and cost, and thus warrant careful evaluation. We found that 4 standard blood tests—complete blood count (CBC) with hemoglobin and platelet counts, albumin, and erythrocyte sedimentation rate (ESR)—were normal in 9% of all children with CD and in 19% of all children with UC,1Mack D.R. Langton C. Markowitz J. et al.Laboratory values for children with newly diagnosed inflammatory bowel disease.Pediatrics. 2007; 119: 1113-1119Crossref PubMed Scopus (126) Google Scholar which is problematic. Our study2Tsampalieros A. Griffiths A.M. Barrowman N. Mack D.R. Use of C-reactive protein in children with newly diagnosed inflammatory bowel disease.J Pediatr. 2011; 159: 340-342Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar referred to a study by Ozgenc et al of 258 children with IBD evaluated the addition of another readily available test, C-reactive protein (CRP). We found that 20% of those children with moderate/severe CD had a normal ESR, but only 1.6% had a normal CRP value, and none when added to the other 4 blood tests. Similar to Ozgenc et al, we found that the ability of blood tests to identify UC in children was not nearly as good, with many children with UC exhibiting normal CBC, albumin, and ESR values.1Mack D.R. Langton C. Markowitz J. et al.Laboratory values for children with newly diagnosed inflammatory bowel disease.Pediatrics. 2007; 119: 1113-1119Crossref PubMed Scopus (126) Google Scholar, 2Tsampalieros A. Griffiths A.M. Barrowman N. Mack D.R. Use of C-reactive protein in children with newly diagnosed inflammatory bowel disease.J Pediatr. 2011; 159: 340-342Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar Even though CRP3Turner D. Mack D.R. Hyams J. et al.C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) or both? A systematic evaluation in pediatric ulcerative colitis.J Crohn’s Colitis. 2011; 5: 423-429Abstract Full Text Full Text PDF PubMed Scopus (49) Google Scholar and newer stool tests4Sylvester F. Turner D. Draghi II, A. et al.Fecal osteoprotegrin may guide the introduction of second-line therapy in hospitalized children with ulcerative colitis.Inflamm Bowel Dis. 2011; 17: 1726-1730Crossref PubMed Scopus (31) Google Scholar may prove beneficial in reflecting longitudinal disease activity and guiding treatment, the addition of CRP will identify only a few more children with mild UC before diagnosis by endoscopy. In our study, the control children undergoing colonoscopy were not infants with cow’s milk allergy. The controls were similar in age (mean age of controls, 12.3 years) and had normal macroscopic and microscopic mucosa. Other mucosal inflammatory conditions would be expected to produce alterations in the blood tests that we evaluated, but this was not the focus of our study. Our data demonstrate that the decision to perform endoscopy in children who are ultimately diagnosed with IBD cannot rely solely on abnormal blood tests (ie, CBC, albumin, ESR, and CRP). There are certain forms of IBD and degrees of disease severity for which clinicians should have a higher index of suspicion for endoscopy despite normal blood test results. We believe that this decision should be made while also taking into account the presence and severity of symptoms and the duration of illness. C-reactive protein in children with active ulcerative colitisThe Journal of PediatricsVol. 160Issue 3PreviewTsampalieros et al1 evaluated the significance of C-reactive protein (CRP) levels and erythrocyte sedimentation rate as an inflammation marker to identify children with inflammatory bowel disease (IBD) among children with gastrointestinal symptoms. Among their patient population with ulcerative colitis (UC), normal CRP levels were documented in 59.3% and 40% in mild and moderate-severe disease, respectively. They have found a sensitivity value of 0.54 (95% CI, 0.44-0.64) for elevated CRP in UC. They have concluded that CRP testing can distinguish patients who will be found to have IBD on endoscopy and recommend the addition of CRP and erythrocyte sedimentation rate in the differential diagnosis. Full-Text PDF