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Discriminating IBD from IBS: Comparison of the test performance of fecal markers, blood leukocytes, CRP, and IBD antibodies

Schoepfer, Alain M. MD1,*; Trummler, Michael MD2; Seeholzer, Petra3; Seibold‐Schmid, Beatrice MSc4; Seibold, Frank MD1

doi: 10.1002/ibd.20275
Original Clinical Articles

Background:: Symptoms of inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) can overlap. We aimed to determine the accuracy of fecal markers, C‐reactive protein (CRP), blood leukocytes, and antibody panels for discriminating IBD from IBS and to define a “best test.”

Methods:: We prospectively included 64 patients with IBD (36 Crohn's disease [CD], 28 ulcerative colitis [UC]), 30 with IBS, and 42 healthy controls. Besides CRP and blood leukocytes, blinded fecal samples were measured for calprotectin (PhiCal Test, enzyme‐linked immunosorbent assay [ELISA]), lactoferrin (IBD‐SCAN, ELISA), Hexagon‐OBTI (immunochromatographic test for detection of human hemoglobin), and LEUKO‐TEST (lactoferrin latex‐agglutination test). Blinded serum samples were measured for the antibodies ASCA (ELISA) and pANCA (immunofluorescence).

Results:: Overall accuracy of tests for discriminating IBD from IBS: IBD‐SCAN 90%, PhiCal Test 89%, LEUKO‐TEST 78%, Hexagon‐OBTI 74%, CRP 73%, blood leukocytes 63%, CD antibodies (ASCA+/pANCA− or ASCA+/pANCA+) 55%, UC antibodies (pANCA+/ASCA−) 49%. ASCA and pANCA had an accuracy of 78% for detecting CD and 75% for detecting UC, respectively. The overall accuracy of IBD‐SCAN and PhiCal Test combined with ASCA/pANCA for discriminating IBD from IBS was 92% and 91%, respectively.

Conclusions:: The PhiCal Test and IBD‐SCAN are highly accurate for discriminating IBD from IBS. There is only marginal additional diagnostic accuracy when the PhiCal Test and IBD‐SCAN are combined with ASCA and pANCA. ASCA and pANCA have a high specificity for IBD.

1Department of Gastroenterology, Inselspital/University of Bern, Switzerland

2Bio‐Analytica Medical Laboratory, Lucerne, Switzerland

3Department of Laboratory Medicine, Kantonsspital Lucerne, Switzerland

4Department of Clinical Research, University of Bern, Switzerland

* Department of Gastroenterology, Inselspital/University of Bern, 3010 Bern, Switzerland (e‐mail: alain.schoepfer@insel.ch)

Received 11 May 2007; Accepted 1 August 2007

Published online 9 October 2007 in Wiley InterScience (www.interscience.wiley.com).

Grant sponsor: Swiss National Science Foundation; Grant Number: SNSF 3200B0‐107527.

Parts of these results were presented as a poster at Digestive Disease Week, Los Angeles, May 20–25, 2006.

© Crohn's & Colitis Foundation of America, Inc.
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