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Accuracy of Four Fecal Assays in the Diagnosis of Colitis

  • Original Contributions
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Diseases of the Colon & Rectum

Purpose

This study was designed to evaluate the accuracy of four different fecal markers in discriminating between irritable bowel syndrome, inflammatory bowel disease, and other forms of colitis and to examine the feasibility of collecting fecal samples in outpatients.

Methods

We prospectively included 20 patients with irritable bowel syndrome, 36 with inflammatory bowel disease (24 Crohn’s disease, 12 ulcerative colitis), and 18 with other forms of colitis (8 infectious colitis, 5 ischemic colitis, 5 medication-induced colitis). Diagnosis was established by clinical, laboratory, and endoscopic workup. Blinded fecal samples were measured for calprotectin (PhiCal™-Test, ELISA), lactoferrin (IBD-SCAN™, ELISA), Hexagon OBTI (immunochromatographic test for detection of human hemoglobin), and LEUKO-TEST (lactoferrin latex-agglutination test).

Results

Overall accuracy for discriminating irritable bowel syndrome from inflammatory bowel disease or other forms of colitis was recorded, respectively: IBD-SCAN™ 91/100 percent, PhiCal™-Test 89/100 percent, LEUKO-TEST 83/89 percent, Hexagon OBTI 77/84 percent, C-reactive protein 71/79 percent, and blood leukocytes 63/68 percent. Differentiation of inflammatory bowel disease from other forms of colitis with fecal markers was as follows: range of overall accuracy from 43 to 50 percent. Overall accuracy (in percent) for discrimination of irritable bowel syndrome from patients with Crohn’s disease in remission (CDAI<150) was: IBD-SCAN™ 90, PhiCal™-Test 90, LEUKO-TEST 85, Hexagon OBTI 77. Calprotectin and lactoferrin were significantly elevated in patients with Crohn’s disease with CDAI>150 compared with those in remission. Fecal sampling feasibility in outpatients was high (acceptance rate 95 percent).

Conclusions

IBD-SCAN™ and PhiCal™-Test have the best overall accuracy for detection of colitis, followed by LEUKO-TEST, Hexagon OBTI, C-reactive protein, and blood leukocytes. Accuracy of fecal markers is high even in patients with Crohn’s disease in remission. Fecal sampling feasibility was high in outpatients. Because fecal markers are unspecific, endoscopic workup remains crucial to determine the underlying cause of colitis.

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References

  1. Talley NJ, Phillips SF, Melton LJ, Mulvihill C, Wiltgen C, Zinsmeister AR. Diagnostic value of the Manning criteria in irritable bowel syndrome. Gut 1990;31:77–81.

    Article  PubMed  CAS  Google Scholar 

  2. Camilleri M, Choi MG. Review article: irritable bowel syndrome. Aliment Pharmacol Ther 1997;11:3–15.

    Article  PubMed  CAS  Google Scholar 

  3. Saverymuttu SH, Peters AM, Lavender JP, Hodgson HJ, Chadwick VS. 111Indium autologous leucocytes in inflammatory bowel disease. Gut 1983;24:293–9.

    Article  PubMed  CAS  Google Scholar 

  4. Segal AW, Ensell J, Munro JM, Sarner M. Indium-111 tagged leucocytes in the diagnosis of inflammatory bowel disease. Lancet 1981;2:230–2.

    Article  PubMed  CAS  Google Scholar 

  5. Saverymuttu SH, Peters AM, Lavender JP, Pepys MB, Hodgson HJ, Chadwick VS. Quantitative fecal indium111-labelled leucocyte excretion in the assessment of disease in Crohn’s disease. Gastroenterology 1983;85:1333–9.

    PubMed  CAS  Google Scholar 

  6. Sugi K, Saitoh O, Hirata I, Katsu K. Fecal lactoferrin as a marker for disease activity in inflammatory bowel disease: comparison with other neutrophil-derived proteins. Am J Gastroenterol 1996;91:927–34.

    PubMed  CAS  Google Scholar 

  7. Naidu A, Satyanarayan Arnold. Influence of lactoferrin on host-microbe interactions. In: William Hutchens T, Lonnerdal B, eds. Lactoferrin. New York: Humana Press, 1997:259–75.

    Google Scholar 

  8. Guerrant RL, Araujo V, Soares E, et al. Measurement of fecal lactoferrin as a marker of fecal leucocytes. J Clin Microbiol 1994;32:2629–30.

    Google Scholar 

  9. Tibble J, Teahon K, Thjodleifsson B, et al. A simple method for assessing intestinal inflammation in Crohn’s disease. Gut 2000;47:506–13.

    Article  PubMed  CAS  Google Scholar 

  10. Kane SV, Sandborn WJ, Rufo PA, et al. Fecal lactoferrin is a sensitive and specific marker in identifying intestinal inflammation. Am J Gastroenterol 2003;98:1309–14.

    Article  PubMed  CAS  Google Scholar 

  11. Best WR, Becktel JM, Singleton JW. Rederived values of the eight coefficients of the Crohn’s Disease Activity Index (CDAI). Gastroenterology 1979;77:843–6.

    PubMed  CAS  Google Scholar 

  12. Daperno M, D’Haens G, Van Assche G, et al. Development and validation of a new, simplified endoscopic activity score for Crohn’s disease: the SES-CD. Gastrointest Endosc 2004;60:505–12.

    Article  PubMed  Google Scholar 

  13. Schroeder KW, Tremaine WJ, Ilstrup DM. Coated oral 5-aminosalicylic acid therapy for mildly to moderately active ulcerative colitis. A randomized study. N Engl J Med 1987;317:1625–9.

    Article  PubMed  CAS  Google Scholar 

  14. Rachmilewitz D. Coated mesalazine (5-aminosalicylic acid) versus sulphasalazine in the treatment of active ulcerative colitis: a randomized trial. BMJ 1989;298:82–6.

    Article  PubMed  CAS  Google Scholar 

  15. Bunn SK, Bisset WM, Main MJ, Gray ES, Olson S, Golden BE. Fecal calprotectin: validation as a noninvasive measure of bowel inflammation in childhood inflammatory bowel disease. J Pediatr Gastroenterol Nutr 2001;33:14–22.

    Article  PubMed  CAS  Google Scholar 

  16. Summerton CD, Longlands MG, Wiener K, Shreeve DR. Faecal calprotectin: a marker of inflammation throughout the intestinal tract. Eur J Gastroenterol Hepatol 2002;14:841–5.

    Article  PubMed  CAS  Google Scholar 

  17. Silberer H, Kuppers B, Mickisch O, et al. Fecal leukocyte proteins in inflammatory bowel disease and irritable bowel syndrome. Clin Lab 2005;51:117–26.

    PubMed  CAS  Google Scholar 

  18. Meling TR, Aabakken L, Roseth A, Osnes M. Faecal calprotectin shedding after short-term treatment with non-steroidal anti-inflammatory drugs. Scand J Gastroenterol 1996;31:339–44.

    PubMed  CAS  Google Scholar 

  19. Scerpella EG, Okhuysen PC, Mathewson JJ, et al. Evaluation of a new latex agglutination test for fecal lactoferrin in travelers’ diarrhea. J Travel Med 1994;1:68–71.

    Article  PubMed  Google Scholar 

  20. Choi SW, Park CH, Silva TM, Zaenker EI, Guerrant RL. To culture or not to culture: fecal lactoferrin screening for inflammatory bacterial diarrhea. J Clin Microbiol 1996;34:928–32.

    PubMed  CAS  Google Scholar 

  21. Shine B, Berghouse L, Jones JE, Landon J. C-reactive protein as an aid in the differentiation of functional and inflammatory bowel disorders. Clin Chim Acta 1985;148:105–9.

    Article  PubMed  CAS  Google Scholar 

  22. Poullis AP, Zar S, Sundaram KK, et al. A new, highly sensitive assay for C-reactive protein can aid the differentiation of inflammatory bowel disorders from constipation- and diarrhoea-predominant functional bowel disorders. Eur J Gastroenterol Hepatol 2002;14:409–12.

    Article  PubMed  CAS  Google Scholar 

  23. Saverymuttu SH, Hodgson HJ, Chadwick VS, Pepys MB. Differing acute phase responses in Crohn’s disease and ulcerative colitis. Gut 1986;27:809–13.

    Article  PubMed  CAS  Google Scholar 

  24. Carlson CS, Aldred SF, Lee PK, et al. Polymorphisms within the C-reactive protein (CRP) promoter region are associated with plasma CRP levels. Am J Hum Genet 2005;77:64–77.

    Article  PubMed  CAS  Google Scholar 

  25. Szalai AJ, McCrory MA, Cooper GS, Wu J, Kimberly RP. Association between baseline levels of C-reactive protein (CRP) and a dinucleotide repeat polymorphism in the intron of the CRP gene. Genes Immun 2002;3:14–9.

    Article  PubMed  CAS  Google Scholar 

  26. Gaya DR, Lyon TD, Duncan A, et al. Faecal calprotectin in the assessment of Crohn’s disease activity. QJM 2005;98:435–41.

    Article  PubMed  CAS  Google Scholar 

  27. Poullis A, Foster R, Mendall MA, Fagerhol MK. Emerging role of calprotectin in gastroenterology. J Gastroenterol Hepatol 2003;18:756–62.

    Article  PubMed  CAS  Google Scholar 

  28. Tibble JA, Sigthorsson G, Foster R, et al. Use of surrogate markers of inflammation and Rome criteria to distinguish organic from nonorganic intestinal disease. Gastroenterology 2002;123:450–60.

    Article  PubMed  Google Scholar 

  29. Hanaway P, Roseth A. Inflammatory biomarkers predict relapse in IBD. Gut 2005;54:1346–7.

    Article  PubMed  CAS  Google Scholar 

  30. Vermeire S, Van Assche G, Rutgeerts P. Laboratory markers in IBD: useful, magic, or unnecessary toys? Gut 55:426–31.

    Article  PubMed  CAS  Google Scholar 

  31. Tibble JA, Sigthorsson G, Bridger S, Fagerhol M, Bjarnason I. Surrogate markers of intestinal inflammation are predictive of relapse in patients with quiescent inflammatory bowel disease. Gastroenterology 2000;119:15–22.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

The authors thank Marcel Zwahlen, Ph.D., Tom Brink, M.D., and Tobias Silzle, M.D., for assistance.

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Authors and Affiliations

  1. Department of Gastroenterology, University Hospital/Inselspital, 3010, Bern, Switzerland

    Alain M. Schoepfer M.D. & Frank Seibold M.D.

  2. Bio-Analytica Medical Laboratory, Lucerne, Switzerland

    Michael Trummler M.D.

  3. Department of Gastroenterology, Kantonsspital, Lucerne, Switzerland

    Dominique H. Criblez M.D.

  4. Department of Laboratory Medicine, Kantonsspital, Lucerne, Switzerland

    Petra Seeholzer

Authors
  1. Alain M. Schoepfer M.D.
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  2. Michael Trummler M.D.
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  3. Petra Seeholzer
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  4. Dominique H. Criblez M.D.
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  5. Frank Seibold M.D.
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Correspondence to Alain M. Schoepfer M.D..

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Schoepfer, A.M., Trummler, M., Seeholzer, P. et al. Accuracy of Four Fecal Assays in the Diagnosis of Colitis. Dis Colon Rectum 50, 1697–1706 (2007). https://doi.org/10.1007/s10350-007-0303-9

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  • DOI: https://doi.org/10.1007/s10350-007-0303-9

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