Monatsschrift Kinderheilkunde

, Volume 165, Issue 7, pp 572–580 | Cite as

Stuhltests in der pädiatrischen Gastroenterologie

Leitthema
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Zusammenfassung

Die Inspektion des Stuhls mit Beurteilung von Menge, Konsistenz, Farbe und Geruch hat in der Pädiatrie eine lange Tradition. Stuhl ist einfach und nichtinvasiv zu gewinnen. Die Indikationen für eine Stuhluntersuchung lassen sich in 4 große Bereiche einteilen: Verdacht auf Darminfektion, Abklärung einer Fehlverdauung (Maldigestion, -absorption), Differenzierung von funktionellen Beschwerden und harmloser Kohlenhydratmalabsorption zu chronisch entzündlichen Darmerkrankungen und Überwachung nach Therapie einer Helicobacter-pylori-Infektion. In dieser Übersicht werden sinnvolle und validierte diagnostische Tests der pädiatrischen Gastroenterologie vorgestellt sowie ihre Wertigkeit und ihre Fehlerquellen aufgezeigt. Da immer mehr Stuhltests auf den Markt kommen, deren Sinnhaftigkeit oder Treffsicherheit nicht durch belastbare Evidenz belegt ist, werden auch diese erwähnt. Falsch-positive Ergebnisse können Eltern, Patient und Arzt verunsichern. Durch falsch-negative Ergebnisse werden Krankheiten nicht oder zu spät erkannt. Unzuverlässige und sinnlose Tests verursachen unnötige primäre und sekundäre Kosten.

Schlüsselwörter

Fäkale Marker Calprotectin α1-Antitrypsin Pankreaselastase Stuhlfett 

Abkürzungen

AP

alkalische Phosphatase

BSG

Blutkörperchensenkungsgeschwindigkeit

CA19–9

„carbohydrate antigen 19-9“

CEA

karzinoembryonales Antigen

CED

chronisch entzündliche Darmerkrankung

CF

zystische Fibrose

CRP

C-reaktives Protein

ECP

eosinophiles kationisches Protein

EHEC

enterohämorrhagische Escherichia coli

ELISA

Enzyme-linked Immunosorbent Assay

EPX

eosinophiles Protein X

K

Kalium

MCT

„medium chain triglyceride“

MG

Molekulargewicht

Na

Natrium

NIRA

„near infrared reflectance analysis“

Stool tests in pediatric gastroenterology

Abstract

The visual inspection of stool to assess volume, consistency, color and smell has a long tradition in pediatric clinical practice. Stool is easy to sample and enables non-invasive investigations. There are four major indications for fecal tests: 1) suspected intestinal infections, 2) suspected malassimilation (e.g. maldigestion or malabsorption), 3) differentiating functional gastrointestinal disorders, such as irritable bowel syndrome or functional pain disorders or benign carbohydrate intolerances (e.g. lactose, sorbit, fructose malabsorption) from inflammatory bowel diseases and 4) monitoring for clearance of Helicobacter pylori infection after therapy. This overview gives a practical approach for useful fecal tests in pediatric gastroenterology addressing the indications and pitfalls. As the usefulness and validity of new diagnostic tests do not need to be proven for marketing, tests with unproven evidential value are frequently used with a high risk of giving misleading results. We discuss some of these inappropriate tests currently in use in Germany. False positive results may induce anxiety in patients, parents and the treating physician, while tests giving false negative results increase the risk for missed or delayed diagnosis. Tests with unproven evidential value may lead to further testing including invasive or potentially harmful investigations and increase of primary and secondary healthcare costs.

Keywords

Fecal markers Calprotectin α1-Antitrypsin Pancreatic elastase Fecal fat 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

S. Koletzko, S. Otte und E. Klucker geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Literatur

  1. 1.
    Bekkali N, Hamers SL, Reitsma JB, van Teledo L, Benninga MA (2009) Infant stool form scale: development and results. J Pediatr 154(4):521–526CrossRefPubMedGoogle Scholar
  2. 2.
    Hsiao CH, Chang MH, Chen HL, Lee HC, Wu TC, Lin CC et al (2008) Universal screening for biliary atresia using an infant stool color card in Taiwan. Hepatology 47(4):1233–1240 (Apr)CrossRefPubMedGoogle Scholar
  3. 3.
    Bähner V, Gehring S (2016) Neonatale Cholestase. Monatsschr Kinderheilkd 164:436. doi: 10.1007/s00112-016-0089-8
  4. 4.
    Borowitz D (2005) Update on the evaluation of pancreatic exocrine status in cystic fibrosis. Curr Opin Pulm Med 11(6):524–527CrossRefPubMedGoogle Scholar
  5. 5.
    Bartels RH, Meyer SL, Stehmann TA, Bourdon C, Bandsma RH, Voskuijl WP (2016) Both exocrine pancreatic insufficiency and signs of pancreatic inflammation are prevalent in children with complicated severe acute malnutrition: an observational study. J Pediatr 174:165–170CrossRefPubMedGoogle Scholar
  6. 6.
    Siegmund E, Lohr JM, Schuff-Werner P (2004) The diagnostic validity of non-invasive pancreatic function tests--a meta-analysis. Z Gastroenterol 42(10):1117–1128CrossRefPubMedGoogle Scholar
  7. 7.
    O’Sullivan BP, Baker D, Leung KG, Reed G, Baker SS, Borowitz D (2013) Evolution of pancreatic function during the first year in infants with cystic fibrosis. J Pediatr 162(4):808–812CrossRefPubMedGoogle Scholar
  8. 8.
    Weintraub A, Blau H, Mussaffi H, Picard E, Bentur L, Kerem E et al (2009) Exocrine pancreatic function testing in patients with cystic fibrosis and pancreatic sufficiency: a correlation study. J Pediatr Gastroenterol Nutr 48(3):306–310CrossRefPubMedGoogle Scholar
  9. 9.
    Kori M, Maayan-Metzger A, Shamir R, Sirota L, Dinari G (2003) Faecal elastase 1 levels in premature and full term infants. Arch Dis Child Fetal Neonatal Ed 88(2):F106–F108CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Ghishan FK, Moran JR, Durie PR, Greene HL (1984) Isolated congenital lipase-colipase deficiency. Gastroenterology 86(6):1580–1582PubMedGoogle Scholar
  11. 11.
    Griffiths AM, Drobnies A, Soldin SJ, Hamilton JR (1986) Enteric protein loss measured by fecal alpha 1‑antitrypsin clearance in the assessment of Crohn’s disease activity: a study of children and adolescents. J Pediatr Gastroenterol Nutr 5(6):907–911CrossRefPubMedGoogle Scholar
  12. 12.
    Prell C, Nagel D, Freudenberg F, Schwarzer A, Koletzko S (2014) Comparison of three tests for faecal calprotectin in children and young adults: a retrospective monocentric study. BMJ Open 4(5):e004558CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Kolho KL, Turner D, Veereman-Wauters G, Sladek M, de Ridder L, Shaoul R et al (2012) Rapid test for fecal calprotectin levels in children with Crohn disease. J Pediatr Gastroenterol Nutr 55(4):436–439CrossRefPubMedGoogle Scholar
  14. 14.
    Kolho KL, Alfthan H, Hamalainen E (2012) Effect of bowel cleansing for colonoscopy on fecal calprotectin levels in pediatric patients. J Pediatr Gastroenterol Nutr 55(6):751–753CrossRefPubMedGoogle Scholar
  15. 15.
    Song JY, Lee YM, Choi YJ, Jeong SJ (2017) Fecal calprotectin level in healthy children aged less than 4 years in South Korea. J Clin Lab Anal. doi: 10.1002/jcla.22113 Google Scholar
  16. 16.
    Kolho KL, Sipponen T, Valtonen E, Savilahti E (2014) Fecal calprotectin, MMP-9, and human beta-defensin-2 levels in pediatric inflammatory bowel disease. Int J Colorectal Dis 29(1):43–50CrossRefPubMedGoogle Scholar
  17. 17.
    Siddiqui I, Majid H, Abid S (2017) Update on clinical and research application of fecal biomarkers for gastrointestinal diseases. World J Gastrointest Pharmacol Ther 8(1):39–46CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Carroccio A, Brusca I, Mansueto P, Soresi M, D’Alcamo A, Ambrosiano G et al (2011) Fecal assays detect hypersensitivity to cow’s milk protein and gluten in adults with irritable bowel syndrome. Clin Gastroenterol Hepatol 9(11):965–971CrossRefPubMedGoogle Scholar
  19. 19.
    Saitoh O, Kojima K, Sugi K, Matsuse R, Uchida K, Tabata K et al (1999) Fecal eosinophil granule-derived proteins reflect disease activity in inflammatory bowel disease. Am J Gastroenterol 94(12):3513–3520CrossRefPubMedGoogle Scholar
  20. 20.
    Koletzko S, Jones NL, Goodman KJ, Gold B, Rowland M, Cadranel S et al (2011) Evidence-based guidelines from ESPGHAN and NASPGHAN for Helicobacter pylori infection in children. J Pediatr Gastroenterol Nutr 53(2):230–243PubMedGoogle Scholar
  21. 21.
    Koletzko S, Konstantopoulos N, Bosman D, Feydt-Schmidt A, van der Ende A, Kalach N et al (2003) Evaluation of a novel monoclonal enzyme immunoassay for detection of Helicobacter pylori antigen in stool from children. Gut 52(6):804–806CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Konstantopoulos N, Russmann H, Tasch C, Sauerwald T, Demmelmair H, Autenrieth I et al (2001) Evaluation of the Helicobacter pylori stool antigen test (HpSA) for detection of Helicobacter pylori infection in children. Am J Gastroenterol 96(3):677–683CrossRefPubMedGoogle Scholar
  23. 23.
    Antos D, Crone J, Konstantopoulos N, Koletzko S (2005) Evaluation of a novel rapid one-step immunochromatographic assay for detection of monoclonal Helicobacter pylori antigen in stool samples from children. J Clin Microbiol 43(6):2598–2601CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Gisbert JP, de la Morena F, Abraira V (2006) Accuracy of monoclonal stool antigen test for the diagnosis of H. pylori infection: a systematic review and meta-analysis. Am J Gastroenterol 101:1921–1930CrossRefPubMedGoogle Scholar
  25. 25.
    Fischbach W, Malfertheiner P, Lynen JP, Bolten W, Bornschein J, Buderus S et al (2016) S2k-guideline Helicobacter pylori and gastroduodenal ulcer disease. Z Gastroenterol 54(4):327–363CrossRefPubMedGoogle Scholar
  26. 26.
    Reese I, Ballmer-Weber B, Beyer K, Fuchs T, Kleine-Tebbe J, Klimek L et al (2017) German guideline for the management of adverse reactions to ingested histamine: guideline of the German Society for Allergology and Clinical Immunology (DGAKI), the German Society for Pediatric Allergology and Environmental Medicine (GPA), the German Association of Allergologists (AeDA), and the Swiss Society for Allergology and Immunology (SGAI). Allergo J Int 26(2):72–79CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Kappler M, Krauss-Etschmann S, Diehl V, Zeilhofer H, Koletzko S (2006) Detection of secretory IgA antibodies against gliadin and human tissue transglutaminase in stool to screen for coeliac disease in children: validation study. BMJ 332(7535):213–214CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Felber J, Aust D, Baas S, Bischoff S, Blaker H, Daum S et al (2014) Results of a S2k-Consensus Conference of the German Society of Gastroenterolgy, Digestive- and Metabolic Diseases (DGVS) in conjunction with the German Coeliac Society (DZG) regarding coeliac disease, wheat allergy and wheat sensitivity. Z Gastroenterol 52(7):711–743CrossRefPubMedGoogle Scholar
  29. 29.
    Husby S, Koletzko S, Korponay-Szabo IR, Mearin ML, Phillips A, Shamir R et al (2012) European society for pediatric gastroenterology, hepatology, and nutrition guidelines for the diagnosis of coeliac disease. J Pediatr Gastroenterol Nutr 54(1):136–160CrossRefPubMedGoogle Scholar

Copyright information

© Springer Medizin Verlag GmbH 2017

Authors and Affiliations

  1. 1.Abteilung für Gastroenterologie und HepatologieKinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, Klinikum der Ludwig-Maximilians-UniversitätMünchenDeutschland

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