Noninvasive tests may suffice in suspected pediatric IBD

Last Updated: 2015-12-21

By David Douglas

NEW YORK (Reuters Health) - Pooled data indicate that noninvasive tests can obviate endoscopy in many children with symptoms suggestive of inflammatory bowel disease (IBD), according to Dutch researchers.

In a December 17 online paper in Pediatrics, Dr. Marjolein Y. Berger of the University of Groningen and colleagues note that such tests "can be used as a triage instrument; they assist in safely ruling out existing IBD and in selecting those patients who are candidates for further investigations."

To determine the utility of such testing, the researchers conducted a literature search and identified 19 studies involving 2,806 children with gastrointestinal symptoms. No studies were of nonreferred children and thus all were deemed to be of moderate to high risk.

Altogether 1,265 children had IBD, with a prevalence ranging from 19% to 82%. Among tests employed were fecal markers, urinary markers, blood markers, ultrasonography, and combinations of tests.

Diagnostic accuracy of individual symptoms and signs was low. Pooled sensitivities for abdominal pain, diarrhea, rectal bleeding, and weight ranged from 0.48 to 0.82 and specificities ranged from 0.17 to 0.78.

Of all the blood markers, C-reactive protein (CRP), used in nine studies, had the best performance, with a pooled sensitivity of 0.63 and specificity 0.88. For albumin, corresponding values were 0.48 and 0.94.

Assessment of fecal calprotectin (FCal) appeared to be the best test overall. This was used in 10 studies and had a pooled sensitivity of 0.99 and a specificity of 0.65. Only three of the 10 studies reported false-negative results.

In fact, the researchers observe, "By testing for FCal, only 18% of the patients without IBD would undergo an invasive procedure because of a false-positive test result."

The team further suggests, "In referred children with a positive FCal test result, CRP or albumin testing could be added because of their low false-positive rate." However, they concede, "Future research is needed to investigate sequential strategies."

Moreover, they conclude, "Before tests or a diagnostic strategy can be recommended in nonreferred, low-risk children, high-quality studies are needed."

Dr. Berger did not respond to requests for comment.

The authors reported no funding or disclosures.

SOURCE: http://bit.ly/1QUQj0G

Pediatrics 2015.