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Occult Blood and Perianal Examination: Value Added in Pediatric Inflammatory Bowel Disease Screening
Christopher J Moran1,2, Jess L Kaplan1,2, Harland S Winter1,2
1Division of Pediatric Gastroenterology, Hepatology, & Nutrition, MassGeneral Hospital for Children.
Insights
Fecal occult blood testing (FOBT) and perianal examination significantly improve the detection of pediatric inflammatory bowel disease (IBD) when combined with standard blood tests. This combined approach enhances diagnostic accuracy in children and adolescents.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Diagnostics
Background:
- Pediatric inflammatory bowel disease (IBD) diagnosis can be challenging, with standard blood tests being normal in up to 20% of cases.
- Early and accurate diagnosis is crucial for effective management of pediatric IBD.
Purpose of the Study:
- To evaluate the diagnostic value of adding fecal occult blood testing (FOBT) and perianal examination to standard laboratory screening for IBD in children and adolescents.
- To determine if this combined approach improves the sensitivity of IBD screening.
Main Methods:
- Retrospective review of medical records for patients undergoing ileocolonoscopy for suspected IBD.
- Analysis of laboratory test results, FOBT, and perianal examination findings prior to ileocolonoscopy.
- Multivariate logistic regression applied to discovery and validation cohorts.
Main Results:
- The combined sensitivity of standard laboratory testing with FOBT and perianal examination reached 97.6% for detecting IBD.
- A predictive model including C-reactive protein, platelet counts, and FOBT with perianal examination was superior to laboratory values alone.
- Standard laboratory testing alone had a sensitivity of 80.5%, while FOBT with perianal examination had a sensitivity of 66.9%.
Conclusions:
- Perianal examination and FOBT are valuable additions to standard laboratory tests for screening pediatric IBD.
- The integration of FOBT and perianal examination significantly enhances the sensitivity of IBD screening in pediatric populations.
Objectives:
Pediatric inflammatory bowel disease (IBD) often presents insidiously and standard blood tests are normal in 20% of patients. We hypothesize that fecal occult blood testing (FOBT) and the perianal examination in addition to blood tests provide important information during the screening process for IBD. The aim of the present study was to measure the diagnostic value of adding FOBT and perianal examination to standard screening laboratories in evaluating children and adolescents for IBD.
Methods:
The medical records of consecutive patients undergoing ileocolonoscopy for IBD were reviewed. Laboratory test results, FOBT, and perianal examination before the decision to perform the ileocolonoscopy were recorded. Standard limits of laboratory tests were used. Multivariate logistic regression was performed on a discovery cohort and applied to an independent validation cohort.
Results:
The discovery cohort included 335 patients (85 IBD and 250 non-IBD). A total of 61.2% had FOBT and perianal examination performed before the decision to perform the ileocolonoscopy. A total of 119 patients had complete blood testing, FOBT, and perianal examination available for full analysis. The sensitivity of the laboratory testing was 80.5% for IBD, and the sensitivity of FOBT with perianal examination was 66.9%. The combined sensitivity of laboratory testing and FOBT with perianal examination was, however, 97.6%. The most predictive model included C-reactive protein, platelet counts, and FOBT with perianal examination and was superior to the laboratory value-only model (P < 0.001) that was validated in a separate cohort.
Conclusions:
Perianal examination and FOBT improve sensitivity in screening children for IBD.
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