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Intestinal permeability compared in pediatric and adult patients with inflammatory bowel disease
R M Issenman1, R T Jenkins, C Radoja
1Department of Pediatrics, McMaster University, Hamilton, Ontario.
Insights
Urinary 51Cr-EDTA excretion is a valuable, non-invasive test for pediatric inflammatory bowel disease (IBD). This method accurately identifies active Crohn's disease (CD) and ulcerative colitis (UC) in children, comparable to adult IBD patient levels.
Area of Science:
- Gastroenterology
- Pediatric Medicine
- Diagnostic Imaging
Background:
- Increased urinary 51Cr-EDTA excretion is a known indicator of active inflammatory bowel disease (IBD) in adults.
- The diagnostic utility of this non-invasive test in pediatric IBD populations, including Crohn's disease (CD) and ulcerative colitis (UC), requires further investigation.
Purpose of the Study:
- To evaluate the efficacy of oral 51Cr-EDTA excretion as a diagnostic marker for active pediatric IBD.
- To compare the results in pediatric IBD patients with those in pediatric and adult controls, as well as adult IBD patients.
Main Methods:
- Seventy-five pediatric IBD patients (51 with active CD, 24 with active UC) and 26 pediatric controls underwent oral administration of 51Cr-EDTA.
- Urine was collected over 24 hours to measure 51Cr-EDTA excretion, with comparisons made to 80 adult controls and adult IBD patients.
- The diagnostic accuracy of the test in the pediatric population was assessed.
Main Results:
- Pediatric controls and adult controls showed median 24-hour 51Cr-EDTA excretion of 1.5% and 1.3%, respectively.
- Increased excretion was observed in 88.2% of pediatric CD patients (median 3.9%/24h) and 66.7% of pediatric UC patients (median 4.8%/24h).
- Pediatric IBD patients exhibited increased 51Cr-EDTA excretion levels comparable to adult IBD patients, with an overall test accuracy of 83.0% in the pediatric cohort.
Conclusions:
- Urinary 51Cr-EDTA excretion is a sensitive and accurate non-invasive test for diagnosing active pediatric IBD.
- This method provides a valuable tool for investigating gastrointestinal symptoms in children, offering results comparable to adult IBD patients.
- The findings support the use of 51Cr-EDTA excretion testing in pediatric gastroenterology practice.
Abstract:
Increased urinary excretion of 51Cr-EDTA after oral administration has been demonstrated in adults with active inflammatory bowel disease (IBD). Pediatric patients with Crohn's disease (CD) and ulcerative colitis (UC) were compared to pediatric and adult controls and adult patients with IBD using this technique. Seventy-five pediatric IBD patients, 51 (mean age 13.8 y) diagnosed with active CD and 24 (mean age 11.9 y) with active UC, were examined. These were compared to 26 pediatric controls with recurrent abdominal pain or chronic non-specific diarrhea. Further comparison was made to 80 adult controls (mean 32.0 y), 63 adults with active CD and 31 adults with active UC. After an overnight fast, 925 kBq of 51Cr-EDTA was given orally and urine collected for 24 h. Excretion of the probe by the pediatric controls and adult controls was 1.5%/24 h and 1.3%/24 h (median), respectively. Of the pediatric patients, 45/51 (88.2%) with active CD (median 3.9%/24 h) and 16/24 (66.7%) with active UC (median 4.8%/24 h) showed increased excretion. Pediatric patients with active IBD demonstrated increased probe excretion comparable to levels of adult patients. In the pediatric population, accuracy of the first test was 83.0%. Thus, urinary excretion of 51Cr-EDTA is a useful non-invasive test in the investigation of pediatric patients with gastrointestinal symptoms.