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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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