Inflammatory bowel disease: no test could safely rule it out.

Clinical bottom line (level 4)

  1. Inflammatory bowel disease was common in children suspected of having it.
  2. Both colonoscopy and white cell scanning can helped diagnose inflammatory bowel disease.
  3. ESR and barium follow-through studies added little to the diagnostic process.
Jobling et al: Archives of Diseases in Children 1996; 74: 22-26
Expires May 2003

The study

Setting: tertiary children's hospital, UK

39 patients (aged range 3.9 to 15 years; median 12, 51% male) children with possible inflammatory bowel disease

Independent blinded reference standard, applied in all patients from a consecutive appropriate spectrum.
Reference standard:
  • histology from biopsy
Diagnostic test:
  • white cell scanning: positive if activity seen in the gut in early stages
  • barium follow-through
  • colonoscopy
  • ESR: positive if > 20 mm/hr

The evidence

pre-test probability of inflammatory bowel disease: 80%, (95% CI: 67% to 92%)

diagnostic test inflammatory bowel disease no inflammatory bowel disease LR+
(95% CI)		 post-test probability LR-
(95% CI)		 post-test probability
ESR positive 21 3 1.8
(0.71 to 4.6) 		88% 0.52
(0.25 to 1.1) 		67%
endoscopy positive 27 1 7.0
(1.1 to 44) 		96% 0.15
(0.06 to 0.38) 		36%
white cell scan positive 28 2 3.6
(1.1 to 12) 		93% 0.13
(0.04 to 0.41) 		33%
total 31 8


diagnostic test inflammatory bowel disease no inflammatory bowel disease LR+
(95% CI)		 post-test probability LR-
(95% CI)		 post-test probability
barium follow-through 10 2 1.5
(0.41 to 5.2) 		83% 0.82
(0.46 to 1.5) 		74%
total 24 7

Comments

  1. Authors altered results that were discordant with other tests in six cases. This combined with the lack of blinding makes these results far less certain.
  2. Colonoscopy has the advantage of allowing biopsies to be taken during the study.
  3. The prevalence of inflammatory bowel disease was extremely high - consequently no test was safely able to exclude it. However in populations with a lower risk of IBD, both endoscopy and white cell scanning can help exclude disease.

Citation

  1. Jobling JC, Lindley KJ, Yousef Y, et al: investigating inflammatory bowel disease - white cell scanning, radiology and colonoscopy. Archives of Diseases in Children 1996; 74: 22-26
Search Terms: colit* in Cochrane
Contributor: Chris Ball and Clare Wotton, October 2000
Reviewer:

Clinical Question.
Patient children with suspected inflammatory bowel disease
Intervention or Exposure white cell scanning, colonoscopy, ESR, barium follow-through
Outcome diagnosis