Urine Test May Detect Childhood Appendicitis

Recognized as the most common cause of emergency surgery in children, appendicitis is an irritation, inflammation, and infection of the appendix. The majority of appendicitis cases occur between the ages of 6 and 20 years with approximately four appendectomies performed for every 1,000 children under the age of 14. Because appendicitis is often difficult to accurately detect in children, the suspicion of the condition leads to the performance of unnecessary surgeries on about 30 percent of the children who undergo them. In addition, 30 to 45 percent of patients suffer an appendix rupture before a diagnosis is made.

With a new technological breakthrough, researchers from the Proteomics Center at Children’s Hospital in Boston have developed a urine test that can detect “biomarkers” indicating appendicitis in children. The promise shown by this new test could lead to improved diagnosis, possibly even replace the use of CT scans, and eliminate the exposure of children to radiation. The details of the research were recently published in the journal Annals of Emergency Medicine.

The appendix is a narrow, elongated tube closed at one end, extending from the cecum, a blind pocket off the first part of the large intestine. Although the exact function of the human appendix is unknown, it plays a role as a part of the body’s immune system during the early years of life. Later, the appendix ceases to function as other organs continue to protect against infection.

Appendicitis occurs when the interior of the appendix gets filled with material such as mucus, stool, or parasites that causes it to swell. This leads to irritation, inflammation, and a decreased blood flow that is inadequate for the body part to maintain health, which causes the appendix to begin to die. An irritated appendix can rapidly become infected and can even rupture, which can quickly become a life-threatening situation. Rupture can occur as holes develop in the walls of the appendix that allow substances to leak into the abdomen. This causes an infection inside the abdomen known as peritonitis.

The researchers at Boston Children’s Hospital evaluated urine samples taken from children before and after an appendectomy. The research group detected several biomarkers, including proteins that are associated with immune response and inflammation. The biomarker that showed the most sensitivity to testing was alpha-2-glycoprotein (LRG).

According to Hanno Steen, the director of proteomics at Children's Hospital Boston, who directed the proteomics work on the study, the discovery of the biomarker was made possible by recent advancements in mass spectrometry technology. Although the research team acknowledged both limitations of the analysis and the need for further studies, Steen noted, “…we are very optimistic that we can push this further," Steen said. “The ultimate hope is to have something in hand that can be used in the clinic as a dipstick test or something like that,” Steen said.

Another goal of the research team is to explore whether or not the protein is present in detectable levels in blood. For patients suffering from abdominal pains, urine testing is common. However, in some cases, such as those involving the testing of infants, blood would be the better choice since infants would need to undergo catheterization prior to urine testing.


source : www.healthnews.com