A Safe Tummy Test

Inflammatory bowel disease in children can be detected with protein test

(RxWiki News) It can take a lot of poking, cash and time to find out what that stomach problem is. For kids, it can be even more difficult to deal with the prodding.

A new study has found a safe way to rule out inflammatory bowel disease in children without needing endoscopy. 

A large proportion of patients who had expensive testing done for IBD actually did not have the disease in the end.

"If your stomach hurts, see a doctor."

The study, led by Els Van de Vijver, MD, from the department of Paediatric Gastroenterology at Antwerp University Hospital in Belgium, aimed to find a way to diagnose children and adolescents with inflammatory bowel disease without sending them to a specialist.

They focused on measuring the amount of calprotectin, a protein with bacteria and fungal properties, in children's stools to see if it can help identify kids with these stomach troubles.

Researchers tested 117 children and teens ranging in age from 6- to 18-years-old that were suspected of having inflammatory bowel disease between February 2009 and June 2010.

They excluded younger children since they normally have higher values of the protein in their fecal matter.

Patients gave a stool sample from home to their doctors who provided a physical examination and blood tests. The study was performed at outpatient clinics at six hospitals in the Netherlands.

Lab technicians did not know whether patients were diagnosed with IBD at the end of the study.

The cases of IBD were confirmed after researchers evaluated and looked at the patients' history according to the European Society for Paediactric Gastroenterology Porto Criteria.

Researchers kept track of the proportion of referred patients who actually had the disease and followed patients who were not selected to have endoscopy in case other symptoms appeared.

Of the 68 children who were referred to have the endoscopy test, researchers found that 42 of the kids actually had inflammatory bowel disease.

Specifically, 24 had Crohn's, 16 had ulcerative colitis and two cases were unclassified.

There were no differences in age and sex between those who had IBD and those who did not have it.

Without knowing the calprotectin results of each patient, doctors had referred 68 patients to a specialist, and 26 or 38 percent of them had a negative result.

If doctors referred patients who had more than 50 μg/g protein in their stools, 54 would have had endoscopy.

The number of endoscopies that do not result in inflammatory bowel disease would be 22 percent without missing a real case of the disease, if patients with stomach infections are excluded before testing.

"At the same time normal calprotectin levels confidently rule out intestinal inflammation and further investigations can be tailored appropriately without referring the patient for endoscopy," the authors said in their report.

"This is good news for patients (less invasive tests) and clinicians (shorter waiting lists for endoscopy)."

Patients who were not diagnosed with IBD either had their symptoms go away after six months or had other tests proving it was something else.

The researchers said that if doctors look at a patient's symptoms combined with a positive test for calprotectin, the disease would be better detected.

And as a result, it reduces the need for referring a patient to a stomach specialist with a very low risk of missing cases.

"In ‘real life’, when another diagnosis than IBD is more likely, pediatricians may wish to avoid this invasive and uncomfortable procedure," the authors said in their report.

The authors note that their study relied on follow-up appointments with the patients to make sure they found all cases of IBD.

The study was published online September 27 in the Archives of Disease in Childhood.

Review Date: 
October 8, 2012