***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background : The correlation between noninvasive markers with endoscopic activity according to the modified Baron Index in patients with ulcerative colitis ( UC ) is unknown . We aim ed to evaluate the correlation between endoscopic activity and fecal calprotectin ( FC ) , C-reactive protein ( CRP ) , hemoglobin , platelets , blood leukocytes , and the Lichtiger Index ( clinical score ) . Methods : UC patients undergoing complete colonoscopy  were prospect ively enrolled and scored clinical ly and endoscopically . Sample s from feces and blood were analyzed in UC patients and controls . Results : We enrolled 228 UC patients and 52 healthy controls . Endoscopic disease activity correlated best with FC ( Spearman 's rank correlation coefficient r = 0.821 ) , followed by the Lichtiger Index ( r = 0.682 ) , CRP ( r = 0.556 ) , platelets ( r = 0.488 ) , blood leukocytes ( r = 0.401 ) , and hemoglobin ( r = −0.388 ) . FC was the only marker that could discriminate between different grade s of endoscopic activity ( grade 0 , 16 [ 10–30 ] & mgr;g/g ; grade 1 , 35 [ 25–48 ] & mgr;g/g ; grade 2 , 102 [ 44–159 ] & mgr;g/g ; grade 3 , 235 [ 176–319 ] & mgr;g/g ; grade 4 , 611 [ 406–868 ] & mgr;g/g ; P < 0.001 for discriminating the different grade s ) . FC with a cutoff of 57 & mgr;g/g had a sensitivity of 91 % and a specificity of 90 % to detect endoscopically active disease ( modified Baron Index ≥2 ) . Conclusions : FC correlated better with endoscopic disease activity than clinical activity , CRP , platelets , hemoglobin , and blood leukocytes . The strong correlation with endoscopic disease activity suggests that FC represents a useful biomarker for noninvasive monitoring of disease activity in UC patients OBJECTIVES : Studies evaluating the correlation between the widely used Simple Endoscopic Score for Crohn 's disease ( SES-CD ) and noninvasive markers are scarce . The aim of this study was to evaluate the correlation between the SES-CD and fecal calprotectin , C-reactive protein ( CRP ) , blood leukocytes , and the Crohn 's disease activity index ( CDAI ) . METHODS : Crohn 's disease patients undergoing complete ileocolonoscopy  were prospect ively enrolled and scored independently according to the SES-CD and the CDAI . SES-CD was defined as follows : inactive 0–3 ; mild 4–10 ; moderate 11–19 ; and high ≥20 . RESULTS : Values in CD patients ( n=140 ileocolonoscopies ) compared with controls ( n=43 ) are as follows : calprotectin , 334±322 vs. 18±5 μg/g ; CRP , 26±29 vs. 3±2 mg/l ; and blood leukocytes , 9.1±3.4 vs. 5.4±1.9 g/l ( all P<0.001 ) . The SES-CD correlated closest with calprotectin ( Spearman 's rank correlation coefficient r=0.75 ) , followed by CRP ( r=0.53 ) , blood leukocytes ( r=0.42 ) , and the CDAI ( r=0.38 ) . Calprotectin was the only marker that could discriminate inactive endoscopic disease from mild activity ( 104±138 vs. 231±244 μg/g , P<0.001 ) , mild from moderate activity ( 231±244 vs. 395±256 μg/g , P=0.008 ) , and moderate from high activity ( 395±256 vs. 718±320 μg/g , P<0.001 ) . The overall accuracy for the detection of endoscopically active disease was 87 % for calprotectin ( cutoff 70 μg/g ) , 66 % for elevated CRP , 54 % for blood leukocytosis , and 40 % for the CDAI ≥150 . CONCLUSIONS : Fecal calprotectin correlated closest with SES-CD , followed by CRP , blood leukocytes , and the CDAI . Furthermore , fecal calprotectin was the only marker that reliably discriminated inactive from mild , moderate , and highly active disease , which underlines its usefulness for activity monitoring OBJECTIVES : There are limited data on the yield of colonoscopy in patients with irritable bowel syndrome ( IBS ) . This study compared the prevalence of structural colonic lesions in patients with suspected non-constipation-predominant IBS and healthy volunteers . We also determined the yield of rectosigmoid biopsies in patients with suspected IBS . METHODS : This was a prospect i ve , case – control study conducted at three US sites . Patients with suspected non-constipation-predominant IBS ( Rome II ) underwent colonoscopy with rectosigmoid biopsies .  Healthy persons undergoing colonoscopy for colorectal cancer screening or polyp surveillance comprised the control group . Abnormalities identified at colonoscopy were compared between suspected IBS and control groups . RESULTS : In all , 466 suspected IBS patients and 451 controls were enrolled . Suspected IBS patients were significantly younger ( P<0.0001 ) and more frequently female ( P<0.0001 ) than controls . The most common lesions in suspected IBS patients were hemorrhoids ( 18.2 % ) , polyps ( 14.6 % ) , and diverticulosis ( 8.8 % ) . Suspected IBS patients had a lower prevalence of adenomas ( 7.7 % vs. 26.1 % , P<0.0001 ) and diverticulosis ( 8.8 % vs. 21.3 % , P<0.0001 ) and higher prevalence of mucosal erythema or ulceration ( 4.9 % vs. 1.8 % , P<0.01 ) compared with controls . Logistic regression found the between-group differences in adenoma prevalence to be robust after correction for demographic factors . The overall prevalence of microscopic colitis in suspected IBS patients was 1.5 % ( 7/466 ) and 2.3 % ( 4/171 ) in those ≥45 years of age . CONCLUSIONS : The prevalence of structural abnormalities of the colon is no higher in suspected non-constipation IBS patients than in healthy controls . Microscopic colitis can be identified in a small proportion of persons with IBS symptoms Background : Symptoms of inflammatory bowel disease ( IBD ) and irritable bowel syndrome ( IBS ) can overlap . We aim ed to determine the accuracy of fecal markers , C‐reactive protein ( CRP ) , blood leukocytes , and antibody panels for discriminating IBD from IBS and to define a “ best test . ” Methods : We prospect ively included 64 patients with IBD ( 36 Crohn 's disease [ CD ] , 28 ulcerative colitis [ UC ] ) , 30 with IBS , and 42 healthy controls . Besides CRP and blood leukocytes , blinded fecal sample s were measured for calprotectin ( PhiCal Test , enzyme‐linked immunosorbent assay [ ELISA ] ) , lactoferrin ( IBD‐SCAN , ELISA ) , Hexagon‐OBTI ( immunochromatographic test for detection of human hemoglobin ) , and LEUKO‐TEST ( lactoferrin latex‐agglutination test ) . Blinded serum sample s were measured for the antibodies ASCA ( ELISA ) and pANCA ( immunofluorescence ) . Results : Overall accuracy of tests for discriminating IBD from IBS : IBD‐SCAN 90 % , PhiCal Test 89 % , LEUKO‐TEST 78 % , Hexagon‐OBTI 74 % , CRP 73 % , blood leukocytes 63 % , CD antibodies ( ASCA+/pANCA− or ASCA+/pANCA+ ) 55 % , UC antibodies ( pANCA+/ASCA− ) 49 % . ASCA and pANCA had an accuracy of 78 % for detecting CD and 75 % for detecting UC , respectively . The overall accuracy of IBD‐SCAN and PhiCal Test combined with ASCA/pANCA for discriminating IBD from IBS was 92 % and 91 % , respectively . Conclusions : The PhiCal Test and IBD‐SCAN are highly accurate for discriminating IBD from IBS . There is only marginal additional diagnostic accuracy when the PhiCal Test and IBD‐SCAN are combined with ASCA and pANCA . ASCA and pANCA have a high specificity for IBD Backgound : Patients being investigated for symptoms of abdominal pain , diarrhoea and or weight loss  often undergo small bowel radiology as part of their diagnostic workup mainly to exclude inflammatory bowel disease Prospect i ve measurements were made of serum C-reactive protein levels and erythrocyte sedimentation rate in sixty-four patients with Crohn 's disease and fifty with ulcerative colitis . The results were related to clinical assessment of disease activity . C-reactive protein levels were raised in both groups but were significantly higher in Crohn 's disease than ulcerative colitis for all categories of disease severity : with mild disease the median and range of C-reactive protein concentration were 4 , 0 - 65 mg/l in Crohn 's disease v. 0 , 0 - 15 mg/l in ulcerative colitis , P less than 0.01 ; in moderate disease the values were 15 , 1 - 100 mg/l v. 3 , 0 - 29 mg/l respectively , P less than 0.05 and in cases of severe disease , 85 , 15 - 183 mg/l v. 12 , 2 - 33 mg/l respectively , P less than 0.001 . Erythrocyte sedimentation rate was also higher in Crohn 's disease but did not closely reflect disease activity in individual patients . C-reactive protein levels corresponded closely with clinical and pathological indices of relapse , remission and response to therapy in patients with Crohn 's disease . The precise assay of serum C-reactive protein provides an objective criterion of inflammatory activity , which may be useful in the assessment , management and study of Crohn 's disease BACKGROUND AND AIMS Assessing the presence and degree of intestinal inflammation objective ly , simply , and reliably is a significant problem in gastroenterology . We assessed faecal excretion of calprotectin  , a stable neutrophil specific marker , as an index of intestinal inflammation and its potential use as a screening test to discriminate between patients with Crohn 's disease and those with irritable bowel syndrome . METHODS The validity of  faecal calprotectin  as a marker of intestinal inflammation was assessed in 22 patients with Crohn 's disease ( 35 studies ) by comparing faecal excretions and concentrations using four day faecal excretion of111indium white cells . A cross sectional study assessed the sensitivity of  faecal calprotectin concentration  for the detection of established Crohn 's disease ( n=116 ) . A prospect i ve study assessed the value of faecal calprotectin  in discriminating between patients with Crohn 's disease and irritable bowel syndrome in 220 patients referred to a gastroenterology clinic . RESULTS Four day faecal excretion of 111indium  ( median 8.7 % ; 95 % confidence interval ( CI ) 7–17 % ; normal < 1.0 % ) correlated significantly ( p<0.0001 ) with daily ( median ranged from 39 to 47 mg ; normal <3 mg ; r=0.76–0.82 ) and four day faecal calprotectin excretion ( median 101 mg ; 95 % CI 45–168 mg ; normal < 11 mg ; r=0.80 ) and single stool calprotectin concentrations ( median 118 mg/l ; 95 % CI 36–175 mg/l ; normal < 10 mg/l ; r=0.70 ) in patients with Crohn 's disease . The cross sectional study showed a sensitivity of 96 % for calprotectin in discriminating between normal subjects ( 2 mg/l ; 95 % CI 2–3 mg/l ) and those with Crohn 's disease ( 91 mg/l ; 95 % CI 59–105 mg/l ) . With a cut off point of 30 mg/l faecal calprotectin  has 100 % sensitivity and 97 % specificity in discriminating between active Crohn 's disease and irritable bowel syndrome . CONCLUSION The calprotectin method may be a useful adjuvant for discriminating between patients with Crohn 's disease and irritable bowel syndrome Purpose This study was design ed to evaluate the accuracy of four different fecal markers in discriminating between irritable bowel syndrome , inflammatory bowel disease , and other forms of colitis and to examine the feasibility of collecting fecal sample s in out patients . Methods We prospect ively included 20 
    Output:
    
None of the biomarkers reliably distinguished between IBS and healthy controls .
Individual analysis of ESR and lactoferrin had little clinical utility .
Conclusion : CRP and calprotectin of ≤0.5 or 40 , respectively , essentially excludes IBD in patients with IBS symptoms .
The addition of CRP and calprotectin to symptom-based criteria may improve the confident diagnosis of IBS