BSPGHAN 2021 Virtual Annual Meeting

27- 29 April 2021

REVIEW THE DIAGNOSIS OF IBD IN CHILDREN WITH AILD (AUTO IMMUNE LIVER DISEASE) -8 YEARS’ EXPERIENCE IN A TERTIARY CENTRE

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Eleni Volonaki
Eleni Volonaki
23 days ago

Did any of these patients have small bowel MRI as part of their investigations, in particular the ones with raised calprotectin but normal endoscopy? What are your thoughts about the patients with low calprotectin and IBD in your study(“mean FC at diagnosis of IDB range 60-4004”) and the patients with raised FC but normal endoscopy (range you gave was 60-332)? What is the cut-off value for calprotectin in your centre and would its positive predictive value change if the cut-off was higher? Thank you.

MARIA MISIOU
MARIA MISIOU
22 days ago
Reply to  Eleni Volonaki

Thank you for your question.
The cut-off value for calprotectin in our centre is 50mg/dl. 3/25 patients with AILD and IBD had low calprotectin ( 60, 86 and 82 respectively),all three diagnosed with IBD and AILD at the same time. All three had mild endoscopic and histological findings, so probably in the very beginning of their disease. Rest had FC > 200. If the cut-off value was higher we would have missed these three patients.
Interestingly we found 8 patients with raised FC and normal endoscopy. In 5/8 FC was performed at the diagnosis of AILD, but only 2 of them had endoscopy early, before starting immunomodulators. The rest were already on treatment and we assume immunomodulators changed our findings. We didn’t look whether these patients had MRE or not.
Half of IBD patients had MRE which was normal.
Thank you.

Jutta Koeglmeier
Jutta Koeglmeier
19 days ago

your patients had a large range of FC. Could you please comment on a particular cut off range that should alert the physician of a possible IBD diagnosis

MARIA MISIOU
MARIA MISIOU
19 days ago

Thank you Jutta. In our cohort most patients with IBD had FC above 200mg/dl.
Patients with bowel symptoms though, should be investigated further regardless the level of FC, especially before starting immunomodulators.