Clinical and laboratory markers of the pre-test probability of inflammatory bowel diseases

Abstract

AIM: to distinguish clinical and laboratory markers that could help to diagnose irritable bowel syndrome (IBS) and forms of inflammatory bowel diseases (IBD) — Crohn`s disease (CD) and ulcerative colitis (UC), before colonoscopy.PATIENTS AND METHODS: the retrospective study included 712 patients (CD — 39.2%, UC — 37.8%, IBS — 23%). Clinical (complaints, anamnesis) and laboratory data from medical histories of patients with confirmed flare of IBD and IBS analyzed.RESULTS: Patients with IBS had significant direct correlations with female gender, constipation, abdominal pain, presence of concomitant functional pathology, absence of extra-intestinal (EIM) and perianal (PAM) manifestations, weight loss due to food restriction (р < 0.001), hemoglobin (р < 0.001) and total protein levels (р = 0.002), and inverse correlations with levels of leukocytes, fecal calprotectin (FC) and C-reactive protein (CRP) (p < 0.0001). Patients with IBD had significant direct correlations with night symptoms (р = 0.045 for CD, р = 0.023 for UC) and diarrhea (up to 2 times per 24 hours in CD, р = 0.018; ≥ 5 times per 24 hours in UC, р < 0.001) and FC (р < 0.001). CD was categorized by the presence of PAMs and EIMs, young age, fever, surgery in anamnesis (p < 0.001), weight loss (p = 0.032), elevated CRP levels, anemia (p < 0.001) and hypoproteinemia (р = 0.032). Patients with UC had direct correlations with male gender (р = 0.008), stool with blood and leukocytosis (р < 0.001) and had inverse correlation with abdominal pain (p < 0.001).CONCLUSION: the identified clinical and laboratory markers can be used as criteria to distinguish IBD from IBS in routine clinical practice. However, further prospective studies are required for validation.