Diagnostic Utility of Non-invasive Tests for Inflammatory Bowel Disease: An Umbrella Review

Abstract

BackgroundThis study aims to consolidate evidence from published systematic reviews and meta-analyses evaluating the diagnostic performances of non-invasive tests for inflammatory bowel disease (IBD) in various clinical conditions and age groups.MethodsTwo independent reviewers systematically identified and appraised systematic reviews and meta-analyses assessing the diagnostic utility of non-invasive tests for IBD. Each association was categorized as adults, children, and mixed population, based on the age ranges of patients included in the primary studies. We classified clinical scenarios into diagnosis, activity assessment, and predicting recurrence.ResultsIn total, 106 assessments from 43 reviews were included, with 17 non-invasive tests. Fecal calprotectin (FC) and fecal lactoferrin (FL) were the most sensitive for distinguishing IBD from non-IBD. However, anti-neutrophil cytoplasmic antibodies (ANCA) and FL were the most specific for it. FC and FL were the most sensitive and specific tests, respectively, to distinguish IBD from irritable bowel syndrome (IBS). Anti-Saccharomyces cerevisiae antibodies (ASCA), IgA, were the best test to distinguish Crohn’s disease (CD) from ulcerative colitis (UC). Interferon-γ release assay was the best test to distinguish CD from intestinal tuberculosis (ITB). Ultrasound (US) and magnetic resonance enterography (MRE) were both sensitive and specific for disease activity, along with the high sensitivity of FC. Small intestine contrast ultrasonography (SICUS) had the highest sensitivity, and FC had the highest specificity for operative CD recurrence.ConclusionIn this umbrella review, we summarized the diagnostic performance of non-invasive tests for IBD in various clinical conditions and age groups. Clinicians can use the suggested non-invasive test depending on the appropriate clinical situation in IBD patients.

Advancing the precision management of inflammatory bowel disease in the era of omics approaches and new technology

“…Another well-accepted fecal biomarker is fecal lactoferrin (FL), the levels of which could also reflect IBD activity and be used to predict disease relapse. Unlike the analysis of FC levels, the advantage of FL is its specificity[ 28 ], and combined analysis of these biomarkers might result in better assessment. In addition, some secondary biomarkers measured using simple laboratory tests, such as the CRP-albumin ratio, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and lymphocyte-monocyte ratio (LMR), can also be used to infer the activity of IBD[ 29 , 30 ].…”

Fecal and Urinary Adipokines as Disease Biomarkers

“…Furthermore, adipokines can also be found in urine and feces, which are easily accessible and provide an opportunity to establish cost-effective, non-invasive tests. Hence, it has been recognized that determining the levels of specific adipokines in urine and/or feces has the potential for risk stratification in patients with different diseases [ 22 , 23 , 24 ].…”

Urinary chemerin as a potential biomarker for inflammatory bowel disease

“…Fecal biomarkers have emerged as tools in diagnosis and monitoring the therapeutic response of IBD. Fecal calprotectin is generally used to monitor intestinal inflammation and to anticipate disease relapse in clinical practice (31,32). This biomarker is released by granulocytes, and therefore, associated with intestinal inflammation.…”