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Screening tests for enteropathy in children
Insights
For childhood enteropathy screening, the D-xylose absorption test and fecal fat test better predict normal jejunal biopsy results than the lactose breath hydrogen test. Combining tests did not improve accuracy.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Accuracy
- Enteropathy Screening
Background:
- Enteropathy in children requires accurate diagnostic methods.
- Lactose breath hydrogen, D-xylose absorption, and fecal fat tests are common screening tools.
- Direct comparison of these tests against jejunal biopsy is lacking.
Purpose of the Study:
- To compare the diagnostic accuracy of three screening tests for childhood enteropathy against jejunal biopsy.
- To determine which screening test best predicts a normal jejunal biopsy result.
Main Methods:
- Retrospective analysis of jejunal biopsy results from July 1983 to July 1984.
- Comparison of biopsy findings with results from lactose breath hydrogen, D-xylose absorption, and fecal fat tests.
Main Results:
- No single screening test was ideal.
- Lactose breath hydrogen test showed low sensitivity and specificity, with poor correlation to biopsy results.
- D-xylose absorption and fecal fat tests showed significant correlation with biopsy results.
- A normal result from either the D-xylose or fecal fat test strongly predicted a normal biopsy.
- Combining multiple tests did not enhance predictive value.
Conclusions:
- The D-xylose absorption test is preferable for screening childhood enteropathy due to its sensitivity and patient compliance.
- Fecal fat determination is also a reliable predictor of normal jejunal biopsy results.
- Further research may explore optimizing screening strategies for pediatric enteropathy.
Abstract:
Three widely used screening tests for enteropathy in childhood are the lactose breath hydrogen test, the one-hour serum D-xylose absorption test, and the 72-hour fecal fat determination. To our knowledge, no study has compared these three tests and jejunal biopsy results. A retrospective survey of all jejunal biopsy results at Children's Hospital, Boston, from July 1983 to July 1984 was undertaken to evaluate which test best predicted a normal biopsy result. None of the screening tests was ideal. The lactose breath test had low sensitivity and specificity and did not correlate significantly with biopsy results. The D-xylose and fecal fat tests were each significantly correlated with biopsy results; a normal result of either test was highly predictive of a normal biopsy result. Combining the results of two or more screening tests did not improve predictive value. The xylose test is preferable on the basis of greater sensitivity and ease of patient compliance.