Combined use of noninvasive tests is useful in the initial diagnostic approach to a child with suspected inflammatory bowel disease.
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.
Canani
Roberto Berni
RB
Department of Pediatrics, University Federico II of Naples, Naples, Italy. berni@unina.it
de Horatio
Laura Tanturri
LT
Terrin
Gianluca
G
Romano
Maria Teresa
MT
Miele
Erasmo
E
Staiano
Annamaria
A
Rapacciuolo
Luciano
L
Polito
Gaetano
G
Bisesti
Vincenzo
V
Manguso
Francesco
F
Vallone
Gianfranco
G
Sodano
Antonio
A
Troncone
Riccardo
R
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
D019268:Antibodies, Antineutrophil Cytoplasmic; D000908:Antibodies, Fungal; D039841:Leukocyte L1 Antigen Complex