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PubMed2002

The efficacy of methotrexate for maintaining remission in inflammatory bowel disease.

BACKGROUND: The management of patients with inflammatory bowel disease who are resistant to or intolerant of azathioprine remains a challenge. Low-dose methotrexate has been shown to be effective in inducing remission in Crohn's disease. AIM: This review was conducted because there are limited long-term follow-up data during and after stopping treatment. There are also limited data on the use of methotrexate in ulcerative colitis. METHODS: The study was a retrospective review of clinical notes. Remission was defined as minimal bowel symptoms without the need for oral steroids for 3 months. Relapse was defined as bowel symptoms that required steroid treatment or surgery. RESULTS: Seventy patients were reviewed; 48 had Crohn's disease and 22 had ulcerative colitis. The mean duration of treatment was 17.1 months; the mean maintenance dose was 20 mg weekly. Remission was achieved in 34 of 55 patients who completed more than 3 months of treatment (62%). Life-table analysis showed that the chances of remaining in remission at 12, 24 and 36 months (if treatment was continued) were 90%, 73% and 51%, respectively. The chances of remaining in remission after stopping treatment at 6, 12 and 18 months were 42%, 21% and 16%, respectively. The dose of methotrexate (mg/kg) was associated with the induction of remission (P=0.02). Treatment was equally effective for Crohn's disease and ulcerative colitis. CONCLUSIONS: Maintenance methotrexate treatment gives acceptable remission rates for treatment periods up to 3 years. After stopping treatment, relapse is frequent and occurs early (usually within 1 year).

Diarrhea↗
PubMed1991

Lower gastrointestinal bleeding in inflammatory bowel disease.

An increasing number of patients with inflammatory bowel disease (IBD) have been observed over the past two to three decades at the Cleveland Clinic. This has allowed extensive follow-up and determination of long-term prognosis. The diseases are chronic, require medication over a long period of time, are frequently associated with the need for operation, and often have complications and recurrences. In addition, a substantial number of patients have onset disease at a young age and thus, the propensity for recurrences and complications makes IBD of significant clinical importance. The symptoms of IBD are chronic and usually include diarrhea and often malnutrition. Rectal bleeding is found in almost all patients with ulcerative colitis and in about 25% of patients with Crohn's disease. However, severe hemorrhage in IBD occurs in a small number (1-5%) of patients. When this occurs, it often does so as an episode which may be associated with severe illness systemically as well as creating diagnostic confusion. For patients with ulcerative colitis, the progressive severity of bleeding may be an important indication for surgery (colectomy); in Crohn's disease, patients with ileocolic location of disease are more likely to have severe hemorrhage, and may require resection as a result. Despite the similarities of Crohn's disease and ulcerative colitis, there are significant differences particularly in the long-term (greater than 10 years) follow-up. For patients with Crohn's disease, the major long-term problem is the need for surgery (2/3-3/4 of patients) and recurrence (+/- 50%).(ABSTRACT TRUNCATED AT 250 WORDS)

Colonic Neoplasms↗
PubMed1991

[Immunosuppression therapy with cyclosporin in inflammatory bowel disease: preliminary experience].

Three patients afflicted with inflammatory bowel disease (1 UC, 1 Crohn's disease, 1 non-filiated colitis), who did not respond to the aggressive treatment from Oxford (3) were treated with immunosuppression therapy with cyclosporin. The dosage was 5-7 mg/day, to obtain seric levels (RIA) between 100-125 ng/ml during 3 months. All patients showed complete remission which was maintained for 6 months after the halt in treatment in the cases of the UC and non-filiated colitis. Parameters of cholestasis appeared with a transient increase of transaminase levels in 1 patient. Another patient suffered a pericarditis sicca which may not necessarily be related to the treatment.

Adult↗
PubMed2002

Value of rectosigmoidoscopy with biopsies for diagnosis of inflammatory bowel disease in children.

BACKGROUND: In children with inflammatory bowel disease (IBD), treatment depends on the type and extent of disease. Therefore, maximal effort should be made to provide a correct diagnosis. The aim of this study was to assess the value of a histologic diagnosis made on the basis of either ileal and colonic or rectosigmoid biopsies. METHODS: In 42 children with a known diagnosis of IBD, biopsies from rectum and sigmoid were reassessed by an expert, blinded pathologist. This histologic diagnosis was compared with the diagnosis based on (ileo)colonic biopsies and the final diagnosis. RESULTS: In patients with IBD, diagnostic accuracy of rectosigmoid histology was 0.4524. For (ileo)colonic biopsies, diagnostic accuracy was 0.7619. CONCLUSIONS: Histology on biopsies from rectum and sigmoid is insufficient for a correct diagnosis of Crohn's disease or ulcerative colitis in children. At initial presentation, an ileocolonoscopy with biopsies should therefore be performed in all children.

Adolescent↗
PubMed1990

Neural patterns in inflammatory bowel disease: an immunohistochemical survey.

The differential diagnosis of inflammatory bowel disease remains a significant diagnostic problem for surgical pathologists. Neural abnormalities, such as hypertrophy of nerve plexi, hyperplasia of ganglion cells, and ultrastructural axonal degeneration have been described in patients with regional enteritis. We performed an immunohistochemical survey of forty cases of regional enteritis, ulcerative colitis, nonspecific colitis, and normal colon. A panel of antibodies, directed against neuron-specific enolase, S-100 protein, synaptophysin, neurofilament protein, and nerve growth factor receptor, was utilized to evaluate the distribution of nerve fibers in paraffin-embedded tissue. Anti-synaptophysin and anti-nerve growth factor receptor highlighted small, arborizing nerve fibers in the mucosa, not apparent in the routinely stained sections. Intense staining of these fibers was observed in regional enteritis with antinerve growth factor receptor. This antibody may aid the discrimination of inflammatory bowel disease from other causes of colonic inflammation and facilitate the identification of regional enteritis in endoscopic biopsies.

Colitis, Ulcerative↗
PubMed2004

Review article: inflammatory bowel disease--empowering the patient and improving outcome.

Inflammatory bowel disease, in common with most chronic diseases, is managed by specialist clinicians during regular clinic follow-up visits. Patients spend approximately 1 h per year with clinicians, with few provisions made for patient participation in their own management for the remainder of the year, resulting in dependence and disempowerment. The provision of regular, fixed clinic appointments for diseases that follow an unpredictable relapsing/remitting pattern results in inefficiencies for health services and inconvenience for patients, as well as high rates of noncompliance. Self-care is a normal human function and accounts for the management of three-quarters of all episodes of ill health. More formalized applications include patients and doctors working collaboratively to develop a set of guidelines which patients use to manage their chronic disease themselves. Recent studies have shown that, in patients with stable ulcerative colitis, self-management results in reduced health service utilization, speedier access to treatment and high levels of patient acceptability, without compromising health outcomes. There are a number of barriers to the effective implementation of guided self-management at many levels. Clinicians may be reluctant to pass control of treatment changes to patients, particularly the use of steroids. Access to clinics at short notice may be difficult and some patients themselves prefer a system in which all decisions are made by doctors. Research into guided self-management is ongoing as the long-term outcomes are uncertain. However, there are indications that passing 'ownership of management' back to patients may improve compliance as patients realize their own responsibilities for remaining well.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1999

Arg506Gln factor V mutation and Val34Leu factor XIII polymorphism in Finnish patients with inflammatory bowel disease.

BACKGROUND: Earlier studies have indicated that inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), is associated with thromboembolic complications, whereas inherited disorders of coagulation occur less often than expected in IBD patients. The point mutation Arg506Gln of factor V (Factor V Leiden), resulting in resistance to activated protein C, is the commonest inherited form of thrombophilia. Alterations in circulating levels of factor XIII (FXIII) have been reported among IBD patients. We investigated whether Factor V Leiden or inherited Val34Leu polymorphism of FXIII would associate with IBD or its clinical outcome. METHODS: Factor V Leiden mutation and FXIII Val34Leu polymorphism were assayed in 328 unrelated Finnish patients with UC and 235 patients with CD by solid-phase minisequencing techniques. The control groups comprised 142 apparently healthy Finnish subjects and 120 Finnish blood donors. RESULTS: The frequency of Factor V Leiden mutation among IBD patients (4.5%) was not significantly different from that in subjects living in the same area (2.1%). No significant differences could be observed in the FXIII Val34Leu polymorphism allele frequencies between patients and controls. Clinical features of IBD, including the disease extent, requirement for immunosuppressive drugs, and occurrence of complications, seemed to be independent of these two clotting factor variants analyzed. CONCLUSIONS: Our data do not support an aetiologic or disease-modifying role for the factor V mutation or factor XIII Val34Leu polymorphism in IBD.

Adult↗
PubMed2004

Discordant erythrocyte sedimentation rate and C-reactive protein in children with inflammatory bowel disease taking azathioprine or 6-mercaptopurine.

BACKGROUND: Inflammatory bowel disease (IBD) is characterized by periods of relapse and remission. Treatment is aimed at reducing symptoms during relapse and prolonging the duration of remissions. 6-Mercaptopurine (6-MP) and its prodrug azathioprine (AZA) are commonly used to prolong clinical remissions. The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are two widely used laboratory markers of inflammation. The authors observed an unexplained discordance between ESR and CRP in children with asymptomatic IBD who were being treated with AZA or 6-MP. OBJECTIVE: To characterize children with IBD in remission treated with 6-MP or AZA who have persistently elevated ESR but normal CRP. METHODS: All patients seen in Pediatric Gastroenterology Clinic between January 1, 1995, and December 31, 2002, with Crohn disease or ulcerative colitis who received AZA or 6-MP continuously for at least 6 months were identified and their medical records reviewed. RESULTS: One hundred twenty patients met the eligibility criteria. Twelve had an ESR >18 mm/hour on at least three occasions during at least 12 consecutive months with a simultaneous CRP <0.8 mg/dL. Eleven of these 12 had no signs or symptoms of active disease and had Pediatric Crohn Disease Activity Index scores <10 for at least 12 consecutive months while the ESR was elevated. Disease duration was similar in the 11 children with asymptomatic disease and with discordant ESR and CRP and in 108 children with concordant ESR and CRP (69.2 + 22.5 months v 54.3 +/- 40.1 months, P = 0.0709). Duration of AZA or 6-MP therapy was greater in the 11 children with asymptomatic disease and discordant ESR and CRP than in those with or without symptoms and with concordant ESR and CRP (58.1 +/- 16.4 months v 36.6 +/- 24.1 months, P = 0.0043). There were no differences between the groups with respect to diagnosis, location of disease, or age at onset of symptoms. The mean corpuscular volume (MCV) was somewhat larger in the children with discordant ESR and CRP than in the children with concordant ESR and CRP (91.4 +/- 6.97 fL v 87.0 +/-7.07 fL, respectively, P = 0.0373); however, in both groups, the MCV was in the normal range. There were no significant differences in hematocrit, white blood cell count, serum albumin, total serum protein, or estimated serum globulin between the groups. CONCLUSIONS: The results suggest that among children treated with AZA or 6-MP, CRP may be a more reliable indirect indicator of inflammation than ESR. This report alerts clinicians that some children taking AZA or 6-MP may have persistent elevation of the ESR with a normal CRP and have no clinical evidence of active disease.

Adolescent↗
PubMed2007

Enhanced intestinal expression of the proteasome subunit low molecular mass polypeptide 2 in patients with inflammatory bowel disease.

PURPOSE: Low molecular mass polypeptide 2 is an inducible immunoproteasome subunit. The expression of low molecular mass polypeptide 2 has not been examined in the intestine of patients with inflammatory bowel disease. This study was designed to determine whether the intestinal expression of low molecular mass polypeptide 2 was enhanced in a group of patients with inflammatory bowel disease compared with a group of control patients without inflammatory bowel disease. Moreover, we examined the association between low molecular mass polypeptide 2 expression and histologic pathology in these patients. METHODS: Twenty-one patients participated in the study. These included six control subjects without inflammatory bowel disease, eight patients with ulcerative colitis, and seven patients with Crohn's disease. Intestinal low molecular mass polypeptide 2 expression was evaluated by immunohistochemistry, as well as by Western blot. Histology scores (0-40 severity scale) were determined on the same sections of intestine as those used for low molecular mass polypeptide 2 histochemistry. RESULTS: By immunohistochemistry, low molecular mass polypeptide 2 expression was significantly enhanced (P < 0.05 vs. control subjects) throughout visibly diseased areas of colon, rectum, and ileum from patients with inflammatory bowel disease. Low molecular mass polypeptide 2 expression also was increased in macroscopically normal intestine from patients with inflammatory bowel disease compared with normal tissue from control subjects. There was a significant correlation (P < 0.0001) between low molecular mass polypeptide 2 expression and histologic pathology in our patients. Western blot results confirmed that low molecular mass polypeptide 2 expression was enhanced in patients with ulcerative colitis (3.1-fold) and in patients with Crohn's disease (3.5-fold). CONCLUSIONS: Intestinal low molecular mass polypeptide 2 expression is significantly increased in inflammatory bowel disease. The association between intestinal low molecular mass polypeptide 2 expression and histologic pathology suggests that this proteasome subunit plays a role in the pathogenesis of inflammatory bowel disease.

Adult↗
PubMed1995

Review article: osteoporosis, corticosteroids and inflammatory bowel disease.

Osteoporosis is a serious complication of inflammatory bowel disease which has not received adequate recognition despite its high prevalence and potentially devastating clinical effects. Its pathogenesis remains poorly defined although corticosteroid therapy and sex hormone deficiency are likely to play a major role. Recent advances in the diagnosis and management of osteoporosis have facilitated early detection of bone loss and identified means by which this may be prevented. Bone density measurements to predict fracture risk and define thresholds for prevention and treatment should be performed routinely in patients with inflammatory disease. Hormone replacement therapy is effective in prevention of bone loss in peri- and post-menopausal patients, but the treatment of younger women and men of all ages requires further study.

Adrenal Cortex Hormones↗
PubMed2006

Inflammatory bowel disease: current therapeutic options.

Medical management of inflammatory bowel diseases (IBD) includes two treatment strategies: induction and maintenance of remission. 5-Aminosalicylates are mostly used for mild active IBD and for maintenance treatment in ulcerative colitis (UC). Glucocorticoids remain, despite their frequent (and occasionally severe) side effects, as the mainstay for induction of remission in moderate to severe active IBD, both UC and Crohn's disease (CD). Cyclosporine and infliximab have emerged as the main, rapid-acting, alternatives in steroid-refractory UC and CD, respectively. Thiopurines (azathioprine and 6-mercaptopurine) are the most efficient and used immunomodulators in IBD; steroid refractoriness, steroid dependency, and long-term maintenance of remission for both UC and CD are their main indications. Methotrexate and infliximab may be used in the same clinical settings as thiopurines in CD, but not in UC; however, these drugs are a second-line treatment because of safety profile and economic costs.

Gastrointestinal Agents↗
PubMed1989

Methotrexate induces clinical and histologic remission in patients with refractory inflammatory bowel disease.

STUDY OBJECTIVE: To determine whether methotrexate has anti-inflammatory activity in refractory inflammatory bowel disease. DESIGN: Nonrandomized, open-label, preliminary trial of methotrexate along with standard medications for 12 weeks. SETTING: Referral-based gastroenterology practice. PATIENTS: Twenty-one patients with refractory inflammatory bowel disease (14, Crohn disease; 7, chronic ulcerative colitis); 17 taking variable doses of corticosteroids and 14 on sulfasalazine or metronidazole. Of the 21 patients, 10 had previously failed azathioprine or 6-mercaptopurine trials. INTERVENTIONS: Sulfasalazine and metronidazole were continued and prednisone dose was tapered according to clinical response. Methotrexate was given as a 25-mg intramuscular injection weekly for 12 weeks, then switched to a tapering oral dose if a clinical and objective improvement was noted. MEASUREMENTS AND MAIN RESULTS: Sixteen of twenty-one patients (11 of 14 patients with Crohn disease, 5 of 7 patients with chronic ulcerative colitis) had an objective response as measured by disease activity indices (modified Crohn's Disease Activity Index, 13.3 to 5.4 [P = 0.0001], Ulcerative Colitis Activity Index, 13.3 to 6.3 [P = 0.007]). Prednisone dosage decreased from 21.4 mg +/- 5.6 (SEM) to 5.5 mg +/- 2.0; P = 0.006 and 38.6 mg +/- 6.35 to 12.9 mg +/- 3.4; P = 0.01, respectively. Five patients with Crohn colitis had colonoscopic healing and 4 had normal histology at 12 weeks. In contrast, none of the 7 patients with ulcerative colitis had normal flexible sigmoidoscopies, despite histologic improvement in 5. Side effects included mild rises in transaminase levels in 2 patients, transient leukopenia in 1, self-limited diarrhea and nausea in 2 patients, and 1 case each of brittle nails and atypical pneumonitis. CONCLUSIONS: Although this pilot study is encouraging, further work is needed before methotrexate can be recommended for inflammatory bowel disease.

Colitis, Ulcerative↗
PubMed1992

Chemiluminescence assay of mucosal reactive oxygen metabolites in inflammatory bowel disease.

Previous studies suggesting increased reactive oxygen metabolite (ROM) production in inflammatory bowel disease have been restricted to peripheral blood and isolated intestinal phagocytes. In the current study, chemiluminescence and the effect of various scavengers, enzymes, and enzyme inhibitors were used to show that ROMs account for the increased production of oxidants by colorectal mucosal biopsy specimens in inflammatory bowel disease. Luminol-amplified chemiluminescence was increased in active ulcerative colitis [macroscopic grade 1: 25 photons.mg-1.min.10(-3) (median), 8-47 (95% confidence intervals), n = 40; grade 2: 89, 65-156, n = 30; grade 3: 247, 133-562, n = 13] and Crohn's disease [mild: 9, 3-84, n = 6; severe: 105, 25-789 (range), n = 5] compared with normal-looking mucosa (ulcerative colitis: 0.8, 0.4-1.4, n = 22, P less than 0.01; Crohn's disease: 0.8, 0.1-2, n = 6, P less than 0.05) and controls (0.6, 0.04-1.4, n = 52, P less than 0.01). In ulcerative colitis, luminol chemiluminescence correlated with microscopic inflammation (Spearman's p = 0.74, P = 0.0001) and was decreased by sodium azide (-89%, P less than 0.05), taurine (-31%, P less than 0.05), catalase (-23%, P less than 0.05), and dimethyl sulfoxide (-29%, P less than 0.05). Superoxide dismutase and oxypurinol decreased lucigenin chemiluminescence in ulcerative colitis by -63% (P less than 0.05) and -27% (P less than 0.05), respectively. Luminol chemiluminescence correlated with lucigenin chemiluminescence (Spearman's rho = 0.72, P = 0.003). These results suggest that neutrophil-derived oxidants (superoxide, hydrogen peroxide, hydroxyl radical, and hypochlorite) are generated in colorectal mucosa in active inflammatory bowel disease and support the hypothesis that production of such metabolites by neutrophils is of major pathogenetic importance.

Acridines↗
PubMed2006

Primary sclerosing cholangitis, inflammatory bowel disease, and colon cancer.

The prevalence of inflammatory bowel disease (IBD) in patients with PSC differs in various part of the world. Ulcerative colitis (UC) is most common, but 1 to 14% of all primary sclerosing cholangitis (PSC) patients have Crohn disease with colonic involvement. Many PSC patients without clinical symptoms of IBD have colonoscopic and histological findings compatible with IBD, and the subclinical phase may last several years before onset of symptoms of active colitis. The characteristics of UC in patients with PSC are different from those in UC patients without PSC. The colitis is usually substantial, the clinical course of the colitis is quiescent, and rectal sparing is common. Moreover, PSC patients with UC have a higher risk of developing colorectal dysplasia/carcinoma than UC patients without PSC. In patients having an ileal pelvic pouch with ileal anal anastomosis, PSC is a risk factor for development of pouchitis. It is important that all PSC patients with UC are included in colonoscopic surveillance programs.

Cholangitis, Sclerosing↗
PubMed1994

Immunopathogenesis of chronic inflammatory bowel disease.

The aetiology and pathogenesis of chronic inflammatory bowel disease are unknown. However, there is circumstantial evidence that immune mechanisms may play a significant role in mediating the gut lesion and various systemic manifestations. The role of the cellular immune system, soluble mediators, including proinflammatory and immunoregulatory cytokines, humoral immunity and mucosal complement activation will be discussed.

Antibody Formation↗
PubMed2000

Cancer in inflammatory bowel disease.

The first case of cancer in inflammatory bowel disease (IBD) was reported at The Mount Sinai Hospital in 1925 in a patient with ulcerative colitis (UC). In 1956, carcinoma of the jejunum was described in a patient with regional enteritis (Crohn's disease [CD]). IBD cancers are preceded by dysplasia, and the relative risk increases with duration of the IBD. CD cancers are more proximally distributed than are UC cancers. Both tend to occur at the site of the overt disease and both develop at earlier ages (47 UC, 50 CD) than in the de novo colorectal cancer (70 years). The absolute cumulative colon cancer frequencies (8% UC, 7% CD) are identical after 20 years, emphasizing the importance of regular surveillance in both types of IBD. Moreover, the increased risk of colon cancer exists in patients with CD even when CD is confined to the small bowel, and patients with IBD have increased risks of developing extraintestinal and reticuloendothelial tumors in both CD and UC, as well as ano-vulval and malignant melanoma in CD. Colitic colorectal cancers are often diffuse, extensive, multiple and right-sided with insidious presentation. The prognosis is no worse after operation than that of de novo colon cancer. Most small bowel cancers in CD are adenocarcinomas, rather than sarcomas, and present at a younger age, more diffusely and more distally than de novo cancers, usually making them undiagnosable at a curable early stage; indeed, two-thirds present with intestinal obstruction. Strictures of the colon are common in patients with IBD, and they have a 10-fold risk for colon cancer, 30-fold for UC, and 6-fold for CD. The risk increases with disease duration. The indications for surgery are absolute, relative and incidental, and the procedures include segmental resection, total proctocolectomy, subtotal colectomy and palliative procedures.

History, 20th Century↗
PubMed1996

Interleukin 8: cells of origin in inflammatory bowel disease.

Neutrophils are important cellular mediators in inflammatory bowel disease (IBD). Interleukin (IL)8, a powerful neutrophil chemoattractant, is found in increased quantities in inflamed mucosa, but the cells of origin are uncertain. IL8 gene expression was studied by in situ hybridisation in uninflamed intestinal tissue resected for colon carcinoma (n = 7) and in inflamed colonic tissue resected for IBD (n = 11). Immunohistochemistry was used to assess the phenotype of IL8 expressing macrophages and the production of IL8 protein. Macrophages isolated from intestinal resections and lipopolysaccharide stimulated peripheral blood monocytes treated with 5-aminosalicylic acid, hydrocortisone, and cyclosporin A were examined for IL8 mRNA by northern blotting and IL8 secretion by enzyme linked immunosorbent assay (ELISA). In all cases IL8 mRNA was detected by in situ hybridisation in macrophages and neutrophils adjacent to ulceration in inflamed bowel, but not detected in uninflamed mucosa from carcinoma resections. Recently recruited CD14 positive macrophages were responsible for some of this IL8 expression. IL8 protein was present in the same distribution as mRNA. Epithelial cells in normal and inflamed tissue showed neither mRNA nor protein. IL8 mRNA was expressed significantly more commonly by macrophages from IBD affected than from normal mucosa, and IL8 secretion by IBD but not normal colon macrophages was augmented significantly by lipopolysaccharide treatment. IL8 expression and production by lipopolysaccharide treated blood monocytes was inhibited by the therapeutic agents tested. These results show that neutrophils and recently recruited macrophages are responsible for production of IL8 in IBD, suggesting a mechanism for a continuing cycle of neutrophil attraction. Agents used therapeutically in these diseases may be effective in part by disrupting this cycle.

Adolescent↗
PubMed2006

Use of serologic markers as a screening tool in inflammatory bowel disease compared with elevated erythrocyte sedimentation rate and anemia.

OBJECTIVES: The purpose of this work was to evaluate the use of serologic testing as a screening test for inflammatory bowel disease compared with erythrocyte sedimentation rate and hemoglobin in a referred patient population with suspected inflammatory bowel disease. PATIENTS AND METHODS: A retrospective study was performed, reviewing medical charts of patients who had inflammatory bowel disease serology performed at Prometheus Laboratories from September 2002 to September 2004. Patients were divided into 4 categories: ulcerative colitis, Crohn disease, indeterminate colitis, and noninflammatory bowel disease groups. Patients were categorized based on clinical evaluation by board-certified pediatric gastroenterologists. RESULTS: A total of 227 patients seen at the Lucile Packard Children's Hospital Gastroenterology Clinic had inflammatory bowel disease serology performed at or before the time of diagnosis. Seventeen charts were excluded secondary to inadequate information. Forty children were found to have inflammatory bowel disease, a prevalence of 19%. Overall, serologic testing for inflammatory bowel disease had 60% sensitivity and 92% specificity. A positive laboratory test for anemia or an elevated erythrocyte sedimentation rate had 83% sensitivity, whereas the combination of anemia and elevated erythrocyte sedimentation rate had 96% specificity. The positive predictive value of serologic testing was 60% compared with 79% in patients with anemia and elevated erythrocyte sedimentation rate. The positive predictive value of serologic testing in the subgroup of subjects without rectal bleeding (139 subjects) was only 35% compared with 60% using routine tests. Almost one third of all positive serologic tests were in patients with no demonstrable inflammatory bowel disease. CONCLUSIONS: As a pediatric inflammatory bowel disease screening strategy for the general pediatrician or gastroenterologist, the measurement of the combination of erythrocyte sedimentation rate and hemoglobin has a higher positive predictive value and is more sensitive, more specific, and less costly than commercial serologic testing.

Adolescent↗