Gastroenterology

Gastroenterology

Volume 123, Issue 2, August 2002, Pages 450-460
Gastroenterology

Clinical–Alimentary Tract
Use of surrogate markers of inflammation and Rome criteria to distinguish organic from nonorganic intestinal disease,☆☆

https://doi.org/10.1053/gast.2002.34755Get rights and content

Abstract

Background & Aims: Differentiating symptoms of irritable bowel syndrome (IBS) from those of organic intestinal disease is a familiar problem for physicians. The aim of this study was to assess the sensitivity, specificity, and odds ratios (ORs) of fecal calprotectin, small intestinal permeability, Rome I criteria, and laboratory markers of inflammation (erythrocyte sedimentation rate [ESR], C-reactive protein [CRP], blood count) in distinguishing organic from nonorganic intestinal disease. Methods: A total of 602 new referrals to a gastroenterology clinic who had symptoms suggestive of IBS or organic intestinal disease were studied for these parameters. All patients underwent invasive imaging (barium/endoscopic examination) and other investigations as appropriate, with physicians blinded to the results of fecal calprotectin and intestinal permeability. Results: A total of 263 patients were diagnosed with organic disease and 339 with IBS. At 10 mg/L, the sensitivity and specificity of calprotectin for organic disease were 89% and 79%, respectively, and that of intestinal permeability for small intestinal disease were 63% and 87%, respectively. Sensitivity of positive Rome criteria for IBS was 85% with a specificity of 71%. An abnormal calprotectin test had an OR for disease of 27.8 (95% confidence interval [CI], 17.6–43.7; P < 0.0001) compared with ORs of 4.2 (95% CI, 2.9–6.1; P < 0.0001) and 3.2 (95% CI, 2.2–4.6; P < 0.0001) for elevated CRP and ESR values. An abnormal permeability test gave an OR of 8.9 (95% CI, 5.8–14.0; P < 0.0001) for small intestinal disease. The OR for IBS with positive Rome criteria was 13.3 (95% CI, 8.9–20.0). Conclusions: Fecal calprotectin, intestinal permeability, and positive Rome I criteria provide a safe and noninvasive means of helping differentiate between patients with organic and nonorganic intestinal disease.

GASTROENTEROLOGY 2002;123:450-460

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)

    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].

    ☆☆

    Supported by NHS Executive South Thames Regional Office grant RDF 039 (to J.A.T.).

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