Performance of blood tests in diagnosis of inflammatory bowel disease in a specialist clinic

AIMS

To determine the reliability of a panel of blood tests in screening for ulcerative colitis and Crohn's disease.

METHODS

The subjects were 153 children referred to a paediatric gastroenterology department with possible inflammatory bowel disease (IBD). Of these, 103 were found to have IBD (Crohn's disease 60, ulcerative colitis 37, indeterminate colitis 6). The 50 without IBD formed the controls. Blood tests evaluated included haemoglobin, platelet count, ESR, CRP, and albumin. Receiver operating characteristic curves were used where possible to determine optimal threshold values. Binary logistic regression analysis was used to investigate the five screening tests in combination, and a stepwise method was used to find the best test combination.

RESULTS

The optimal screening strategy used a combination of haemoglobin and platelet count and "1 of 2 abnormal" as the criterion for positivity. This was associated with a sensitivity of 90.8% (95% CI 83.3 to 95.7%), a specificity of 80.0% (95% CI 65.7 to 89.8%), and positive and negative predictive values of 94.4% and 75.9% respectively.

CONCLUSIONS

Haemoglobin and platelet count provide a useful screening test combination for patients with suspected IBD. These tests are not completely reliable however. If clinical suspicion is high further investigations are required.

Epidemiology of coeliac disease in children in one Croatian county: possible factors that could affect the incidence of coeliac disease and adherence to a gluten-free diet (Part II)

Coeliac disease is a life-long disorder characterised by small-intestinal mucosal damage caused by gluten. The treatment, gluten-free diet, leads to mucosal restoration and reduces the risk of malignant and non-malignant complications. According to our recent results, cumulative incidence in Croatian children is 1:519 life-births. Coeliac disease presents early, mostly with typical symptoms. We investigated possible influences of breast-feeding duration and time of gluten introduction on such presentation of the disease. Study included coeliacs born in Medimurje between 1985 and 1994 (N = 31). Patients' adherence to treatment was also studied. Although short breast-feeding (mean 2.9 months) and early gluten introduction (mean 4.9 months) were shown, no correlation was found between those factors and time of the disease presentation. Concerning adherence to gluten-free diet, only 50% of patients maintained it strictly, 23% irregularly, while 27% were on normal diet. In order to improve it, regular follow-ups are recommended.

Epidemiology of coeliac disease in children in one Croatian county: the cumulative incidence over ten-year period and the way of clinical presentation (Part I)

Coeliac disease is a permanent intolerance to gluten, producing small-intestinal lesions. Its incidence in European countries varies from 1:400 to 1:2000, while there are no such epidemiological data for Croatia. Therefore, we investigated the incidence of coeliac disease for ten-year period in one well-defined region. Also, data concerning age at diagnosis and symptoms at the disease onset were collected. The cumulative incidence was 1.9:1000 life-births. The disease presented typically in more than 60% of cases. In 65% of patients, symptoms appeared during the first 2 years of life, while, when diagnosed, 45% were below 2 years. Also, it was shown that coeliac disease presented significantly later in children diagnosed during the last five years (p < 0.05). In conclusion, coeliac disease in Croatia is more frequent than previously suspected. It presents early, mostly with classical symptoms, although a tendency towards later ages of diagnosis was observed during the last few years.

War victims in need of physical rehabilitation in Croatia

A Rehabilitation Information System was created in July 1993 in order to register war victims in need of physical rehabilitation all over Croatia. The system is currently operating and presented data covers the period from July 1991 to July 1995. Approximately 15,000 questionnaires had been completed and returned from medical institutions on in total 8589 disabled war victims in need of rehabilitation. People with severe disabilities comprised about 20% of all in need of rehabilitation. Those reported injured were 3.5 times more than those in need of physical rehabilitation. Most common types of injuries were fractures with a permanent disabling condition (3109 persons), peripheral nerve injuries (1213 persons) and amputations (956 persons). Traumatic brain injuries were registered for 594 and spinal cord injuries for 262 persons. Causes of injuries were explosive devices (such as mines, mortar shell shrapnel, etc.) in 37% of cases, bullets in 22%, accidents in 7%, other (such as fire, blast injuries, etc.) and unknown causes in 34%.