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ABSTRACT: Capsule endoscopy has been shown to be useful in diagnosing small bowel Crohn's disease. Faecal lactoferrin has been shown to have a high sensitivity and specificity in discriminating between inflammatory bowel disease and irritable bowel syndrome. There have been no studies on the use of faecal lactoferrin in the setting of suspected Crohn's disease using capsule endoscopy. Our aim was to investigate the clinical utility of lactoferrin in patients with suspected Crohn's disease using capsule endoscopy.
Data was collected prospectively on patient symptoms, family history and blood parameters. Patients were requested to return a stool sample and quantitative analysis using sandwich ELISA was performed for faecal lactoferrin.
Seventeen patients were recruited with all patients having had more than one criterion for referral. The diagnostic yield for capsule endoscopy was 41%, of which 71% of patients had an elevated faecal lactoferrin (correlation coefficient 0.56, p=0.01). The sensitivity, specificity, positive predictive value and negative predictive value of faecal lactoferrin were 71%, 100%, 100% and 83%, respectively.
Faecal lactoferrin has a high positive and negative predictive value for the diagnosis of small bowel Crohn's disease, detected by capsule endoscopy. Faecal lactoferrin is a useful marker (in conjunction with clinical parameters) to determine which patients should be referred for capsule endoscopy.
Journal of gastrointestinal and liver diseases: JGLD 09/2010; 19(3):257-60. · 1.81 Impact Factor
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ABSTRACT: Celiac disease is associated with exocrine pancreatic insufficiency. We previously reported that in 30% (20/66) of adult celiac patients with current or persistent diarrhea the underlying cause was exocrine pancreatic insufficiency. Of these 20 patients, 19 initially improved on pancreatic supplementation. To date, there are no published longitudinal studies.
The 20 patients who had initially received therapy for exocrine pancreatic insufficiency were prospectively followed-up for 4 years. Gastrointestinal symptoms, dietary adherence, celiac antibody status, and dose of enzyme supplementation were recorded. Fecal elastase-1 (Fel-1) was repeated to reassess exocrine pancreatic function.
In the study, 19/20 patients were reviewed, as one had died (mean age 59.7 years, 7 males). The mean duration of celiac disease was 13.2 years. Eleven out of nineteen were still taking enzyme supplementation at a mean dose of 45,000 units of lipase per day. Only 1/11 reported no symptomatic benefit and 8/19 patients had discontinued supplementation because their diarrhea had improved. In the whole group there was a significant increase in Fel-1 levels over time, with median values of 90 μg/g at 0 months, 212 μg/g at 6 months, and 365 μg/g at follow-up (45-66 months)(p < 0.0001).
Fecal elastase-1 is useful in identifying exocrine pancreatic insufficiency in adult celiac patients with diarrhea. Our longitudinal data suggests that pancreatic enzyme supplementation could be discontinued in a substantial proportion of patients as symptoms improve.
Digestive Diseases and Sciences 05/2010; 55(10):2999-3004. · 2.12 Impact Factor
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ABSTRACT: Patients with irritable bowel syndrome (IBS) might have other underlying pathologies. Pancreatic disease can be elusive-especially in the early stages, and some symptoms overlap with those of IBS. We evaluated the prevalence of exocrine pancreatic insufficiency in diarrhea-predominant IBS (D-IBS) and assessed the effects of pancreatic enzyme supplementation.
The study included patients who met the Rome II criteria for D-IBS, patients with chronic diarrhea, and subjects without diarrhea (controls). Subjects' baseline weight, stool frequency, stool consistency (using the Bristol score), and fecal elastase-1 (Fel-1) levels were determined. Patients were assessed using British Society of Gastroenterology IBS guidelines. Patients with Fel-1 levels less than 100 microg/g stool (indicating pancreatic exocrine insufficiency; group 1) were compared with age- and sex-matched patients with D-IBS and normal levels of Fel-1 (group 2), given pancreatic enzyme therapy, and reassessed at 12 weeks.
Fel-1 levels were less than 100 microg/g in stool from 19 of 314 patients with D-IBS (6.1%; 95% confidence interval [CI], 3.7%-9.3%), none of the 105 patients with chronic diarrhea (95% CI, 0.0%-3.5%), and none of 95 controls (95% CI, 0.0-3.8%) (P < .001). After enzyme supplementation, improvements in stool frequency (P < .001), stool consistency (P < .001), and abdominal pain (P = .003) were observed in patients in group 1, but not in group 2.
Pancreatic exocrine insufficiency was detected in 6.1% of patients who fulfilled the Rome II criteria for D-IBS. In these patients, pancreatic enzyme therapy might reduce diarrhea and abdominal pain. Pancreatic exocrine insufficiency should be considered in patients with D-IBS.
Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association 10/2009; 8(5):433-8. · 5.64 Impact Factor
