Inflammatory bowel disease in pediatric patients

Optimal management of chronic idiopathic inflammatory bowel disease requires determination of disease localization and intensity. Scintigraphy with the use of 99mTc-HMPAO-White Blood Cells (99mTc-HMPAO-WBC) is a relatively new noninvasive nuclear medicine procedure. We have evaluated more than 230 children and have found a high correspondence between the disease distribution shown by the 99mTc-HMPAO-WBC scan and that shown by endoscopic, radiologic, or surgical methods. Additionally the 99mTc-HMPAO-WBC scan has the ability of identifying extra intestinal site of inflammation, such as appendicitis and others. The erythrocyte sedimentation rate, the most frequently used indicator of disease activity in the clinical setting, has better correlation with the scan scores than the clinical activity index. The 99mTc-HMPAO-WBC scan is reliable in differentiating Crohn's disease from ulcerative colitis. Some patients because of unequivocal demonstrable small bowel uptake are reclassified from ulcerative colitis to Crohn's disease. The medication regimen is frequently altered because of the intensity of uptake displayed by the 99mTc-HMPAO-WBC scan. It is a practical and safe study even in an acutely ill patient who may not tolerate endoscopic or radiological study. At our institution, the 99mTc-HMPAO-WBC scan is now part of the initial evaluation, and follow-up of patients with inflammatory bowel disease. In conclusion the 99mTc-HMPAO-WBC is excellent for the detection, localization and characterization of inflammatory bowel disease in children. Compared with the other methods of investigation this study requires no bowel preparation, is noninvasive and has excellent diagnostic accuracy.