Diagnostic accuracy of noninvasive IBD biomarkers unclear

Last Updated: 2015-06-03

By Reuters Staff

NEW YORK (Reuters Health) - Noninvasive biomarkers have the potential to diagnose inflammatory bowel disease (IBD), but endoscopy remains the gold standard, according to a new report.

Serum C-reactive protein (CRP), fecal calprotectin (FC), and stool lactoferrin (SL) are useful biomarkers that might help doctors triage patients with active IBD for endoscopy, but their value in managing individual patients may vary, researchers write in the American Journal of Gastroenterology, online May 12.

In people with IBD, endoscopic disease activity is linked with poor outcomes. While endoscopy remains the most relied-upon test for evaluating symptomatic patients, it is invasive and resource-intensive.

Noninvasive biomarkers offer an alternative approach, but their diagnostic accuracy is unclear, according to the authors, led by Dr. Mahmoud H. Mosli of the University of Western Ontario in London, Ontario, Canada.

Dr. Mosli and his co-authors searched MEDLINE, EMBASE and other databases from their inception through late 2014 for relevant cohort and case-control studies that evaluated the diagnostic accuracy of CRP, FC, or SL and used endoscopy as a gold standard in patients with symptoms of active UC or Crohn's disease (CD).

Of the 2,516 studies the researchers screened, they included 18 prospective studies and one retrospective study in their review.

Of the nearly 2,500 participants in the studies, 1,069 had UC, 1,033 had CD and the rest were either IBS patients or healthy volunteers used as controls.

The pooled sensitivity estimate for CRP was 0.49, while for FC it was 0.92 and for SL, 0.88. The pooled specificities were 0.73, 0.82 and 0.79, respectively.

FC was more sensitive in ulcerative colitis than in Crohn's disease. In both diseases, it was more sensitive than CRP, the researchers say.

They add that the poor specificity of FC in Crohn's disease (0.68) is a concern because it could mean that patients without endoscopically active disease would end up being treated.

The authors point out several limitations of their analysis, including the small number of studies, the majority of studies having been published only as abstracts, the lack of additional information about subpopulations and the quality of reporting.

"Larger studies are needed to further characterize these biomarkers and determine their optimal applications in clinical practice," they advised.

The author could not be reached for comments.

SOURCE: http://bit.ly/1K9tIu9

Am J Gastroenterol 2015.