Canani Roberto Berni, de Horatio Laura Tanturri, Terrin Gianluca, Romano Maria Teresa, Miele Erasmo, Staiano Annamaria, Rapacciuolo Luciano, Polito Gaetano, Bisesti Vincenzo, Manguso Francesco, Vallone Gianfranco, Sodano Antonio, Troncone Riccardo
Department of Pediatrics, University Federico II of Naples, Naples, Italy.
J Pediatr Gastroenterol Nutr. 2006 Jan;42(1):9-15. doi: 10.1097/01.mpg.0000187818.76954.9a.
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).
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.
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.
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.
评估粪便钙卫蛋白（FC）、抗酿酒酵母抗体（ASCA）、核周型抗中性粒细胞抗体（pANCA）、小肠通透性试验（IP）和肠壁超声测量（BWUS）联合使用在疑似炎症性肠病（IBD）儿童诊断检查中的有效性。
所有因可能患有IBD而前来进行初步评估的儿童均符合条件。有症状或体征（右下腹肿块、肛周疾病或便血）需要对IBD进行全面检查的患者被排除。所有入选患者均接受了包括活检检查在内的临床、实验室、影像学和内镜评估。在初始评估时对所有患者进行免疫球蛋白（Ig）G和IgA ASCA、IgG pANCA、FC、IP和BWUS检测。
27例患者最终诊断为IBD：17例克罗恩病和10例溃疡性结肠炎。18名儿童有其他胃肠道诊断（8例功能性肠病、5例食物过敏介导的疾病、4例感染性小肠结肠炎、1例家族性地中海热）。FC、BWUS和ASCA/pANCA同时出现异常值的患者，患IBD的估计概率为99.47%。所有检测结果均为阴性的患者患IBD的概率为0.69%。
在儿童IBD诊断初期不确定时，将非侵入性诊断检查纳入初始诊断方法可避免不必要的侵入性操作并有助于临床决策。
