title: Combined use of noninvasive tests is useful in the initial diagnostic approach to a child with suspected inflammatory bowel disease.
abstract: OBJECTIVE
  To assess the effectiveness of the combined use of fecal calprotectin (FC), anti-Saccharomyces cerevisiae antibody (ASCA), perinuclear staining antineutrophil antibody (pANCA), small intestinal permeability test (IP), and bowel wall ultrasonography measurement (BWUS) in the diagnostic work-up of children with suspected inflammatory bowel disease (IBD).
  
  
  METHODS
  All children referred for initial assessment of possible IBD were eligible. Patients with symptoms or signs (right-lower quadrant mass, perianal disease, or hematochezia) mandating a complete work-up for IBD were excluded. All enrolled patients underwent a clinical, laboratory, radiographic, and endoscopic evaluation including biopsy examinations. The immunoglobulin (Ig)G and IgA ASCA, IgG pANCA, FC, IP, and BWUS were tested in all patients at the initial assessment.
  
  
  RESULTS
  A final diagnosis of IBD was made in 27 patients: 17 Crohn disease and 10 ulcerative colitis. Eighteen children had other gastrointestinal diagnoses (8 functional bowel disorders, 5 food allergy-mediated diseases, 4 infectious enterocolitis, 1 familial Mediterranean fever). In patients with simultaneous abnormal values of FC, BWUS, and ASCA/pANCA, the estimated probability of having IBD was 99.47%. Patients with negative results on all tests had a 0.69% of probability of IBD.
  
  
  CONCLUSIONS
  The incorporation of noninvasive diagnostic tests into the initial diagnostic approach may avoid unnecessary invasive procedures and facilitate clinical decision-making when the diagnosis of IBD in children is initially uncertain.
authors.affiliation: Department of Pediatrics, University Federico II of Naples, Naples, Italy. berni@unina.it
authors.forename: Roberto Berni
authors.initials: RB
authors.lastname: Canani
authors.forename: Laura Tanturri
authors.initials: LT
authors.lastname: de Horatio
authors.forename: Gianluca
authors.initials: G
authors.lastname: Terrin
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Romano
authors.forename: Erasmo
authors.initials: E
authors.lastname: Miele
authors.forename: Annamaria
authors.initials: A
authors.lastname: Staiano
authors.forename: Luciano
authors.initials: L
authors.lastname: Rapacciuolo
authors.forename: Gaetano
authors.initials: G
authors.lastname: Polito
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Bisesti
authors.forename: Francesco
authors.initials: F
authors.lastname: Manguso
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Vallone
authors.forename: Antonio
authors.initials: A
authors.lastname: Sodano
authors.forename: Riccardo
authors.initials: R
authors.lastname: Troncone
mesh_terms: D000293:Adolescent; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000032:analysis*; D000908:Antibodies, Fungal / Q000032:analysis*; D002648:Child; D003093:Colitis, Ulcerative / Q000175:diagnosis / Q000276:immunology / Q000473:pathology; D003424:Crohn Disease / Q000175:diagnosis / Q000276:immunology / Q000473:pathology; D003937:Diagnosis, Differential; D003955:Diagnostic Tests, Routine / Q000379:methods / Q000592:standards*; D005243:Feces / Q000737:chemistry; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology; D007421:Intestine, Small / Q000000981:diagnostic imaging / Q000473:pathology / Q000502:physiology; D039841:Leukocyte L1 Antigen Complex / Q000032:analysis*; D008297:Male; D010539:Permeability; D015203:Reproducibility of Results; D012441:Saccharomyces cerevisiae / Q000276:immunology; D012680:Sensitivity and Specificity; D014463:Ultrasonography
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic; D000908:Antibodies, Fungal; D039841:Leukocyte L1 Antigen Complex