Inflammatory bowel disease: elevated ANCA or ASCA helped diagnose it in children

Clinical bottom line (level 1b)

  1. 40% of children with suspected inflammatory bowel disease had it.
  2. The following made inflammatory bowel disease more likely:
    • elevated ASCA or ANCA: (LR + 13)
    • weight loss and/or short stature: (LR + 4.3)
  3. No diarrhoea made inflammatory bowel disease less likely (LR - 0.18) .
Dubinsky et al: Am J Gastroenterol 2001; 96 : 758-765
Expires May 2004

The study

Setting: paediatric gastroenterology service, university hospital, Canada

128 patients (aged 4 to 19; median 12, 54% female) with suspected inflammatory bowel disease

Independent blinded reference standard, applied in all patients from a consecutive appropriate spectrum.
Reference standard:
  • colonoscopy with biopsies and upper GI series with small bowel follow-through
Diagnostic test: serological blood tests
  • ANCA
  • pANCA
  • ASCA: anti-Saccharomyces cerevisiae antibodies

The evidence

pre-test probability of Inflammatory bowel disease: 42%, (95% CI: 34% to 51%)

diagnostic test IBD not IBD LR+
(95% CI)		 post-test probability LR-
(95% CI)		 post-test probability
family history of IBD (first or second degree relative) 28 16 2.4
(1.4 to 4.0) 		64% 0.61
(0.45 to 0.83) 		31%
diarrhoea 48 28 2.3
(1.7 to 3.2) 		63% 0.18
(0.082 to 0.39) 		12%
weight loss and/or short stature 22 7 4.3
(2.0 to 9.3) 		76% 0.65
(0.52 to 0.83) 		32%
ASCA IgA > 20 or IgG > 40 EU/ml, or ANCA > mean 20 EU/ml 37 4 13
(4.8 to 33) 		90% 0.33
(0.22 to 0.50) 		20%
ASCA IgA > 12, IgG > 60 or ANCA > 14 EU/ml 44 21 2.9
(2.0 to 4.2) 		68% 0.26
(0.15 to 0.46) 		16%
total 54 74

Comments

  1. Abdominal pain and iron-deficiency anaemia were not clearly associated with inflammatory bowel disease.
  2. 87% of childern with inflammatory bowel disease had Crohn's disease.
  3. 60% of children without inflammatory bowel disease had recurrent abdominal pain of childhood.

Citation

  1. Dubinsky MC, Ofman JJ, Urman M, et al: clinical utility of serodiagnostic testing in suspected pediatric inflammatory bowel disease. Am J Gastroenterol 2001; 96 : 758-765
Search Terms: from ACP Journal Club other articles noted
Contributor: Chris Ball, May 2002
Reviewer:

Clinical Question.
Patient children with suspected inflammatory bowel disease
Intervention or Exposure clinical features, ANCA, ASCA
Outcome inflammatory bowel disease