Clinical–Alimentary TractUse of surrogate markers of inflammation and Rome criteria to distinguish organic from nonorganic intestinal disease☆,☆☆
Section snippets
Materials and methods
We prospectively studied 602 consecutive patients referred to and seen in a gastroenterology outpatient department of a teaching hospital by general practitioners in South London. All patients had clinical symptoms suggestive of organic small or large intestinal disease or IBS that had not responded to therapy instituted by the primary care physician and were of sufficient severity for further consultation and investigation to exclude organic pathology. A total of 231 men and 371 women were
Patient diagnosis
Each patient underwent one or more invasive diagnostic imaging procedures of the gastrointestinal tract as the gold standard, appropriate to their symptoms. In total, 372 patients had a full colonoscopy (including terminal ileal intubation), 5 had an endoscopic retrograde cholangiopancreatography, 15 had an enteroscopy, and 85 had an esophagogastroduodenoscopy, of whom 38 had both a colonoscopy and esophagogastroduodenoscopy. A further 65 patients had incomplete colonoscopy and underwent barium
Discussion
This study shows both fecal calprotectin level and the Rome I criteria to be significantly better screening discriminates of patients with organic or nonorganic intestinal disease (OR, 27.8 and 13.3) than some other commonly used laboratory parameters, such as CRP (OR, 4.2) and ESR (OR, 3.2). In addition, the differential urinary excretion of lactulose/L-rhamnose is a good predictor of small intestinal disease (OR, 8.9). We have also shown that both the site and likelihood of organic disease
Acknowledgements
The authors thank Prof. Magne Fagerhol (Department of Immunology, Ulleval University Hospital, Oslo, Norway) for supplying the anti-calprotectin antibody for use in the enzyme-linked immunosorbent assay and for his technical support throughout the project.
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Cited by (0)
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Address requests for reprints to: Jeremy A. Tibble, M.D., M.R.C.P., Digestive Diseases Centre, Level 9A, Royal Sussex County Hospital, Eastern Road, Brighton, East Sussex BN2 5BE, England. e-mail: [email protected].
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Supported by NHS Executive South Thames Regional Office grant RDF 039 (to J.A.T.).