title: Use of surrogate markers of inflammation and Rome criteria to distinguish organic from nonorganic intestinal disease.
abstract: OBJECTIVE
  Differentiating symptoms of irritable bowel syndrome (IBS) from those of organic intestinal disease is a familiar problem for physicians. The aim of this study was to assess the sensitivity, specificity, and odds ratios (ORs) of fecal calprotectin, small intestinal permeability, Rome I criteria, and laboratory markers of inflammation (erythrocyte sedimentation rate [ESR], C-reactive protein [CRP], blood count) in distinguishing organic from nonorganic intestinal disease.
  
  
  METHODS
  A total of 602 new referrals to a gastroenterology clinic who had symptoms suggestive of IBS or organic intestinal disease were studied for these parameters. All patients underwent invasive imaging (barium/endoscopic examination) and other investigations as appropriate, with physicians blinded to the results of fecal calprotectin and intestinal permeability.
  
  
  RESULTS
  A total of 263 patients were diagnosed with organic disease and 339 with IBS. At 10 mg/L, the sensitivity and specificity of calprotectin for organic disease were 89% and 79%, respectively, and that of intestinal permeability for small intestinal disease were 63% and 87%, respectively. Sensitivity of positive Rome criteria for IBS was 85% with a specificity of 71%. An abnormal calprotectin test had an OR for disease of 27.8 (95% confidence interval [CI], 17.6-43.7; P < 0.0001) compared with ORs of 4.2 (95% CI, 2.9-6.1; P < 0.0001) and 3.2 (95% CI, 2.2-4.6; P < 0.0001) for elevated CRP and ESR values. An abnormal permeability test gave an OR of 8.9 (95% CI, 5.8-14.0; P < 0.0001) for small intestinal disease. The OR for IBS with positive Rome criteria was 13.3 (95% CI, 8.9-20.0).
  
  
  CONCLUSIONS
  Fecal calprotectin, intestinal permeability, and positive Rome I criteria provide a safe and noninvasive means of helping differentiate between patients with organic and nonorganic intestinal disease.
authors.affiliation: Department of Medicine, Guy's, Kings, St. Thomas' Medical School, London, England. jeremy.tibble@virgin.net
authors.forename: Jeremy A
authors.initials: JA
authors.lastname: Tibble
authors.forename: Gudmundur
authors.initials: G
authors.lastname: Sigthorsson
authors.forename: Russell
authors.initials: R
authors.lastname: Foster
authors.forename: Ian
authors.initials: I
authors.lastname: Forgacs
authors.forename: Ingvar
authors.initials: I
authors.lastname: Bjarnason
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D015415:Biomarkers; D003109:Colonic Diseases, Functional / Q000175:diagnosis*; D003937:Diagnosis, Differential; D016099:Endoscopy, Gastrointestinal; D005243:Feces / Q000737:chemistry*; D005260:Female; D006801:Humans; D007410:Intestinal Diseases / Q000175:diagnosis*; D039841:Leukocyte L1 Antigen Complex; D008297:Male; D008562:Membrane Glycoproteins / Q000032:analysis*; D008875:Middle Aged; D019006:Neural Cell Adhesion Molecules / Q000032:analysis*; D010539:Permeability; D011446:Prospective Studies; D012680:Sensitivity and Specificity
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D015415:Biomarkers; D039841:Leukocyte L1 Antigen Complex; D008562:Membrane Glycoproteins; D019006:Neural Cell Adhesion Molecules