Discriminating irritable bowel syndrome from inflammatory bowel disease: what is the role of biomarkers in daily practice?

Background and Aims: Discriminating irritable bowel syndrome (IBS) from inflammatorybowel disease (IBD) can be a clinical challenge as symptoms can overlap. We and othershave recently shown that fecal calprotectin (FC) is more accurate for discriminating IBSfrom IBD compared to C-reactive protein (CRP) and blood leukocytes. Data on the biomarkersused in daily gastroenterological practice are lacking. We therefore aimed to assess whichbiomarkers are used by gastroenterologists in their daily practice for discriminating IBSfrom IBD.Methods: A questionnaire was sent to all board certified gastroenterologists inSwitzerland focusing on demographic informations, number of IBS patients treated in thetime period from May 2009 to April 2010, and the specific biomarkers evaluated fordiscriminating IBS from IBD.Results: Response rate was 57% (153/270). Mean physician'sage was 50±9years, mean duration of gastroenterologic practice 14±8years, 52% of themwere working in private practice and 48% in hospitals. Thirty-nine percent had taken careof more than 100 IBS patients in the last 12 months, 37% had seen 41-100 and 24% hadseen 1-40 IBS patients. Gastroenterologists in private practice more frequently took care ofat least 40 IBS patients in a year compared to hospital-based gastroenterologists (P<0.001).The following biomarkers were determined for discriminating IBS from IBD: CRP 100%,FC 79%, hematogram (red blood cells and leukocytes) 70%, iron status (ferritin, transferrinsaturation) 59%, erythrocyte sedimentation rate 2.7%, protein electrophoresis 0.7%, andalpha-1 antitrypsin clearance 0.7%. There was a trend for using FC more often in privatepractice than in hospital (P = 0.08). Twenty-four percent of gastroenterologists had usedFC in the workup of more than 70% of patients classified as IBS, 22% had used FC in 30-70% of IBS patients, 39% in less than 30%, and 15% had never used FC for the work-upof suspected IBS. Eighty-nine percent of gastroenterologists considered FC to be superiorto CRP for discriminating IBS from IBD, 87% thought that patient's compliance for fecalsampling is high, and 51% judged the fee of USD 60 for a FC test as appropriate.Conclusions:FC is widely used in clinical practice to discriminate IBS from IBD. In accordance with thescientific evidence, the majority of gastroenterologists consider FC to be more accurate thanCRP for discriminating IBS from IBD. Gastroenterologists in private practice take care ofsignificantly more IBS patients than colleagues in hospital.

Dietary intake of children with inflammatory bowel disease and of healthy controls

Introduction: The assessment of dietary intake by examination is a tool that allows knowing the habits and detecting certain nutritional deficiencies. Thus, it is essential in chronic disease and especially in children, where deficiencies can have a negative impact on growth and pubertal development. Objectives: Compare the dietary intake between children with inflammatory bowel disease (IBD) and healthy controls. Methods: Twenty-nine healthy controls (12 girls; mean age: 12.7 ± 1.9 years) and 21 IBD patients (11 girls; 14.3 ± 1.3 years) recruited from August 2011 to October 2012. Dietary intake was assessed by 24h recall. Results: No differences were found between IBD patients and healthy controls regarding dietary intake (table). Both IBD patients and healthy controls had excessive protein consumption. Furthermore, there are deficiencies for some nutriments (fibers, calcium and magnesium). Qualitative analysis revealed that both, IBD patients and healthy controls showed increased snacking and bad lipids distribution, especially for saturated lipids. Conclusion: Both children with IBD and health controls have a food imbalance and a low intake of minerals and vitamins. No differences between children with IBD and healthy controls were found.

E-1 Monthly Statistical Movement Summary for Entire Iowa Department of Corrections, Iowa Department of Corrections, February 2001

Monthly Statistical Movement Summary for Entire Iowa Department of Corrections

E-1 Monthly Statistical Movement Summary for Entire Iowa Department of Corrections, Iowa Department of Corrections, May 2001

Monthly Statistical Movement Summary for Entire Iowa Department of Corrections

E-1 Monthly Statistical Movement Summary for Entire Iowa Department of Corrections, Iowa Department of Corrections, April 2001

Monthly Statistical Movement Summary for Entire Iowa Department of Corrections

E-1 Monthly Statistical Movement Summary for Entire Iowa Department of Corrections, Iowa Department of Corrections, May 2001

Monthly Statistical Movement Summary for Entire Iowa Department of Corrections

E-1 Monthly Statistical Movement Summary for Entire Iowa Department of Corrections, Iowa Department of Corrections, June 2001

Monthly Statistical Movement Summary for Entire Iowa Department of Corrections

E-1 Monthly Statistical Movement Summary for Entire Iowa Department of Corrections, Iowa Department of Corrections, July 2001

Monthly Statistical Movement Summary for Entire Iowa Department of Corrections

E-1 Monthly Statistical Movement Summary for Entire Iowa Department of Corrections, August 2001

Monthly Statistical Movement Summary for Entire Iowa Department of Corrections

E-1 Monthly Statistical Movement Summary for Entire Iowa Department of Corrections, September 2001

Monthly Statistical Movement Summary for Entire Iowa Department of Corrections

E-1 Monthly Statistical Movement Summary for Entire Iowa Department of Corrections, Iowa Department of Corrections, November 2001

Monthly Statistical Movement Summary for Entire Iowa Department of Corrections

E-1 Monthly Statistical Movement Summary for Entire Iowa Department of Corrections, Iowa Department of Corrections, November "A" 2001

Monthly Statistical Movement Summary for Entire Iowa Department of Corrections

E-1 Monthly Statistical Movement Summary for Entire Iowa Department of Corrections, Iowa Department of Corrections, December 2001

Monthly Statistical Movement Summary for Entire Iowa Department of Corrections

E-1 Monthly Statistical Movement Summary for Entire Iowa Department of Corrections, Iowa Department of Corrections, January 2002

Monthly Statistical Movement Summary for Entire Iowa Department of Corrections