Diagnosis of Crohn's disease. A continuing source of error.

Dyer, N. H.; Dawson, A. M.

doi:10.1136/bmj.1.5698.735

Cited by 32 publications

(7 citation statements)

References 16 publications

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“…Why fever should occur predominantly in the younger age group is a mystery; in this series the presence of unexplained pyrexia led to 7 incorrect diagnoses. This is in contrast to an earlier survey from this hospital that included all age groups when only 2% of the patients were misdiagnosed as suffering from a febrile illness (Dyer and Dawson, 1970). Crohn's disease should clearly be excluded in clhildren suffering fevers of unknown origin.…”

Section: O'donoghue and Dawsoncontrasting

confidence: 58%

Crohn's disease in childhood.

O’Donoghue¹,

Dawson²

1977

Archives of Disease in Childhood

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In 32 patients with Crohn's disease which started in childhood, abdominal pain, diarrhoea, and weight loss were the common presenting symptoms, but unexplained fever and failure to grow were also prominent. Stunted growth was the most frequent physical abnormality when first seen in hospital. The mean delay in diagnosis was almost 3 years and the principal contributing factor here was failure to consider the diagnosis and thus perform a barium follow-through examination. The cumulative relapse rate after medical therapy or surgical resection was disappointingly high, but because the median relapse time is much longer for surgically treated patients, surgery is recommended at an early stage, especially in those patients who are growth-retarded or whose education is suffering because of time lost from school.

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Section: O'donoghue and Dawsoncontrasting

confidence: 58%

Crohn's disease in childhood.

O’Donoghue¹,

Dawson²

1977

Archives of Disease in Childhood

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“…The clinical value of the diagnostic test with the four strains combined was therefore evaluated from results in patients with Crohn's disease and healthy subjects. As the average period of time between onset of symptoms and diagnosis of Crohn's disease is 3-4 years (Dyer & Dawson, 1970;Brandes & Eulenburg, 1976) it is evident that a number of sera submitted for diagnostic purposes are from patients with symptoms suggesting the disease but in which the diagnosis has not yet been established. At present, the lapse of time after the serological test is too short to interpret positive reactions in these patients conclusively.…”

Section: Discussionmentioning

confidence: 99%

Serum agglutinins toEubacteriumandPeptostreptococcusspecies in Crohn's and other diseases

Wensinck

Merwe

1981

J. Hyg.

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SUMMARYSera from patients suffering from Crohn's and other diseases and from healthy subjects were tested for agglutinins to anaerobic, gram-positive coccoid rods belonging to species of Eubacterium and Peptostreptococcus. Four strains labelled Eubacterium contortum (two strains), Eubacterium rectale and Peptostreptococcus productus were agglutinated by a higher percentage of sera from patients with Crohn's disease than from healthy subjects and from patients with liver and intestinal diseases (including ulcerative colitis), ankylosing spondylitis, granulomatous diseases, diseases of immunity and malignancies.The agglutinins were of the IgG and IgM classes and strain-specific; the titres were low.The results obtained with sera from patients with Crohn's disease and healthy people were subjected to discriminant analysis to estimate the probability, based on the combined results with the four strains, that a patient suffers from Crohn's disease. When sera giving an a posteriori probability > 0-95 (a priori probability = 0-5) were considered positive, the test with four strains had a sensitivity of54 % and q. specificity ofnearly 100 %. The results with sera submitted for diagnosis showed that positive reactions in patients with a diagnosis apparently incompatible with Crohn's disease were within acceptable limits.

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“…This difficulty is partly overcome by verification via the split-sample method, but ideally the predictive value of a diagnostic test for clinical use should be evaluated via a comparison of the patient population with a similar population that only differs by the absence of the particular disease. The final classification of patients as 'CD' or 'non-CD', however, requires long-term studies as the average period of time between onset of symptoms of Crohn's disease and diagnosis is 4 years (Dyer & Dawson, 1970;Brandes & Eulenburg, 1976;Mekhjian et al 1979).…”

Section: Discussionmentioning

confidence: 99%

Antibodies toEubacteriumandPeptostreptococcusspecies and the estimated probability of Crohn's disease

Merwe

Schmitz

Wensinck

1981

J. Hyg.

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Anaerobic coccoid rods belonging to species of Eubacterium and Peptostreptococcus agglutinate more frequently with sera from patients with Crohn's disease than with sera from patients suffering from other diseases and from healthy subjects. Results of agglutination test with four strains of coccoid anaerobes were used to estimate the probability that a patient suffers from Crohn's disease. The data on healthy subjects and patients with Crohn's disease were subjected to logistic discriminant analysis. With the methods and interpretation described, 52% of the patients with Crohn's disease were recognized as 'definite' or 'probable' Crohn's disease and 14% as 'suspected'. Only 1% of the healthy subjects were classified as 'suspected' and non as 'definite' or 'probable' Crohn's disease.

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Diagnosis of Crohn's disease. A continuing source of error.

Cited by 32 publications

References 16 publications

Crohn's disease in childhood.

Crohn's disease in childhood.

Serum agglutinins toEubacteriumandPeptostreptococcusspecies in Crohn's and other diseases

Antibodies toEubacteriumandPeptostreptococcusspecies and the estimated probability of Crohn's disease

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