Combined use of noninvasive tests is useful in the initial diagnostic approach to a child with suspected inflammatory bowel disease

J Pediatr Gastroenterol Nutr. 2006 Jan;42(1):9-15. doi: 10.1097/01.mpg.0000187818.76954.9a.


Objective: To assess the effectiveness of the combined use of fecal calprotectin (FC), anti-Saccharomyces cerevisiae antibody (ASCA), perinuclear staining antineutrophil antibody (pANCA), small intestinal permeability test (IP), and bowel wall ultrasonography measurement (BWUS) in the diagnostic work-up of children with suspected inflammatory bowel disease (IBD).

Methods: All children referred for initial assessment of possible IBD were eligible. Patients with symptoms or signs (right-lower quadrant mass, perianal disease, or hematochezia) mandating a complete work-up for IBD were excluded. All enrolled patients underwent a clinical, laboratory, radiographic, and endoscopic evaluation including biopsy examinations. The immunoglobulin (Ig)G and IgA ASCA, IgG pANCA, FC, IP, and BWUS were tested in all patients at the initial assessment.

Results: A final diagnosis of IBD was made in 27 patients: 17 Crohn disease and 10 ulcerative colitis. Eighteen children had other gastrointestinal diagnoses (8 functional bowel disorders, 5 food allergy-mediated diseases, 4 infectious enterocolitis, 1 familial Mediterranean fever). In patients with simultaneous abnormal values of FC, BWUS, and ASCA/pANCA, the estimated probability of having IBD was 99.47%. Patients with negative results on all tests had a 0.69% of probability of IBD.

Conclusions: The incorporation of noninvasive diagnostic tests into the initial diagnostic approach may avoid unnecessary invasive procedures and facilitate clinical decision-making when the diagnosis of IBD in children is initially uncertain.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Antibodies, Antineutrophil Cytoplasmic / analysis*
  • Antibodies, Fungal / analysis*
  • Child
  • Colitis, Ulcerative / diagnosis
  • Colitis, Ulcerative / immunology
  • Colitis, Ulcerative / pathology
  • Crohn Disease / diagnosis
  • Crohn Disease / immunology
  • Crohn Disease / pathology
  • Diagnosis, Differential
  • Diagnostic Tests, Routine / methods
  • Diagnostic Tests, Routine / standards*
  • Feces / chemistry
  • Female
  • Humans
  • Inflammatory Bowel Diseases / diagnosis*
  • Inflammatory Bowel Diseases / immunology
  • Inflammatory Bowel Diseases / pathology
  • Intestine, Small / diagnostic imaging
  • Intestine, Small / pathology
  • Intestine, Small / physiology
  • Leukocyte L1 Antigen Complex / analysis*
  • Male
  • Permeability
  • Reproducibility of Results
  • Saccharomyces cerevisiae / immunology
  • Sensitivity and Specificity
  • Ultrasonography


  • Antibodies, Antineutrophil Cytoplasmic
  • Antibodies, Fungal
  • Leukocyte L1 Antigen Complex