title: Diagnosis of ischemic small bowel disease by measurement of serum intestinal fatty acid-binding protein in patients with acute abdomen: a multicenter, observer-blinded validation study.
abstract: BACKGROUND
  Intestinal fatty acid-binding protein (I-FABP) is a low-molecular-mass (15 kDa) cytosolic protein found exclusively in the epithelial cells of the small bowel mucosa. We aimed to evaluate the clinical usefulness of serum I-FABP measurement for the diagnosis of ischemic small bowel disease.
  
  
  METHODS
  Patients with a clinical diagnosis of acute abdomen were recruited for this multicenter trial at one university hospital and nine city hospitals over a 13-month period. Serum I-FABP levels were measured in 361 eligible patients by an enzyme-linked immunosorbent assay using a specific monoclonal antibody.
  
  
  RESULTS
  Of the 361 patients, 242 underwent surgery, and small bowel ischemia was diagnosed in 52 patients. The mean serum I-FABP level in the patients with small bowel ischemia was 40.7 ± 117.9 ng/ml, which was significantly higher than that in patients with non-ischemic small bowel disease (5.8 ± 15.6 ng/ml) and those with non-small bowel disease (1.8 ± 1.7 ng/ml). The serum I-FABP cutoff level for the diagnosis of small bowel ischemia was 3.1 ng/ml. Serum I-FABP was more efficient than conventional biochemical markers, in terms of sensitivity and positive and negative predictive values, in the diagnosis of small bowel ischemia. However, its specificity was slightly lower than that of creatinine phosphokinase or lactate dehydrogenase. The positive and negative likelihood ratios of serum I-FABP were 3.01 and 0.29, respectively.
  
  
  CONCLUSIONS
  Serum I-FABP measurement is a non-invasive method that is potentially useful for the efficient identification of patients with acute abdomen who are at risk of small bowel ischemia.
authors.affiliation: Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Niigata 951-8510, Japan. kandat@med.niigata-u.ac.jp
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Kanda
authors.forename: Akihiro
authors.initials: A
authors.lastname: Tsukahara
authors.forename: Kyo
authors.initials: K
authors.lastname: Ueki
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Sakai
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Tani
authors.forename: Atsushi
authors.initials: A
authors.lastname: Nishimura
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Yamazaki
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Tamiya
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Tada
authors.forename: Masaki
authors.initials: M
authors.lastname: Hirota
authors.forename: Jun
authors.initials: J
authors.lastname: Hasegawa
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Funaoka
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Fujii
authors.forename: Katsuyoshi
authors.initials: K
authors.lastname: Hatakeyama
mesh_terms: D000006:Abdomen, Acute / Q000175:diagnosis / Q000209:etiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D004797:Enzyme-Linked Immunosorbent Assay; D050556:Fatty Acid-Binding Proteins / Q000097:blood*; D005260:Female; D006801:Humans; D007410:Intestinal Diseases / Q000097:blood / Q000175:diagnosis* / Q000473:pathology; D007421:Intestine, Small / Q000098:blood supply*; D007511:Ischemia / Q000097:blood / Q000175:diagnosis* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D055815:Young Adult
chemical_list: D050556:Fatty Acid-Binding Proteins