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Ansems SM, Berger MY, Pieterse E, Nanne S, Beugel GG, Couwenberg RPE, Holtman GA. Management of children with non-acute abdominal pain and diarrhea in Dutch primary care: a retrospective cohort study based on a routine primary care database (AHON). Scand J Prim Health Care 2023; 41:267-275. [PMID: 37427876 PMCID: PMC10478593 DOI: 10.1080/02813432.2023.2231054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 06/25/2023] [Indexed: 07/11/2023] Open
Abstract
OBJECTIVE To describe the testing, prescription, referral, and follow-up management by general practitioners (GPs) for children presenting with non-acute abdominal pain and/or diarrhea in primary care. DESIGN Retrospective cohort study with one-year follow-up. SETTING Registry data from a Dutch primary care database (AHON) between 2015 and 2019. SUBJECTS Children aged 4-18 years old who presented by face-to-face consultation in primary care for non-acute abdominal pain and/or diarrhea (>7 days). MAIN OUTCOME MEASURES We recorded the proportions of children who received (1) diagnostic testing, medicine prescriptions, follow-up consultations, and referrals at their first visit and (2) repeat consultations and referrals by one-year of follow-up. RESULTS Among the 2200 children (median age, 10.5 years; interquartile range, 7.0-14.6) presenting to a GP with non-acute abdominal pain and/or diarrhea, most reported abdominal pain (78.7%). At the first visit, GPs performed diagnostic testing for 32.2%, provided a prescription to 34.5%, and referred 2.5% to secondary care. Twenty-five percent of the children had a follow-up consultation within four weeks and 20.8% had a repeat consultation between four weeks and one year. Thirteen percent of the children were referred to secondary care by one year. However, only 1% of all children had documentation of an organic diagnosis needing management in secondary care. CONCLUSION One-third of children received diagnostic testing or a medicine prescription. Few had a follow-up consultation and >10% was referred to pediatric care. Future research should explore the motivations of GPs why and which children receive diagnostic and medical interventions.
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Affiliation(s)
- Sophie M. Ansems
- Department of Primary and Long-term Care, University Medical Center Groningen, Groningen, the Netherlands
| | - Marjolein Y. Berger
- Department of Primary and Long-term Care, University Medical Center Groningen, Groningen, the Netherlands
| | - Elaine Pieterse
- Department of Primary and Long-term Care, University Medical Center Groningen, Groningen, the Netherlands
| | - Sjaantje Nanne
- Department of Primary and Long-term Care, University Medical Center Groningen, Groningen, the Netherlands
| | - Gina G. Beugel
- Department of Primary and Long-term Care, University Medical Center Groningen, Groningen, the Netherlands
| | - Ria P. E. Couwenberg
- Department of Primary and Long-term Care, University Medical Center Groningen, Groningen, the Netherlands
| | - Gea A. Holtman
- Department of Primary and Long-term Care, University Medical Center Groningen, Groningen, the Netherlands
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Ansems S, Berger M, Rheenen PV, Vermeulen K, Beugel G, Couwenberg M, Holtman G. Effect of faecal calprotectin testing on referrals for children with chronic gastrointestinal symptoms in primary care: study protocol for a cluster randomised controlled trial. BMJ Open 2021; 11:e045444. [PMID: 34301652 PMCID: PMC8311316 DOI: 10.1136/bmjopen-2020-045444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Children with chronic gastrointestinal symptoms are frequently seen in primary care, yet general practitioners (GPs) often experience challenges distinguishing functional gastrointestinal disorders (FGID) from organic disorders. We, therefore, aim to evaluate whether a test strategy that includes point-of-care testing (POCT) for faecal calprotectin (FCal) can reduce the referral rate to paediatric specialist care among children with chronic gastrointestinal symptoms. The study findings will contribute to improving the recommendations on FCal use among children in primary care. METHODS AND ANALYSIS In this pragmatic cluster randomised controlled trial, we will randomise general practices into intervention and control groups. The intervention group will use FCal-POCT when indicated, after completing online training about its indication, interpretation and follow-up as well as communicating an FGID diagnosis. The control group will test and treat according to Dutch GP guidelines, which advise against FCal testing in children. GPs will include children aged 4-18 years presenting to primary care with chronic diarrhoea and/or recurrent abdominal pain. The primary outcome will be the referral rate for children with chronic gastrointestinal symptoms within 6 months after the initial assessment. Secondary outcomes will be evaluated by questionnaires completed at baseline and at 3- and 6-month follow-up. These outcomes will include parental satisfaction and concerns, gastrointestinal symptoms, impact of symptoms on daily function, quality of life, proportion of children with paediatrician-diagnosed FGID referred to secondary care, health service use and healthcare costs. A sample size calculation indicates that we need to recruit 158 GP practices to recruit 406 children. ETHICS AND DISSEMINATION The Medical Research Ethics Committee (MREC) of the University Medical Center Groningen (The Netherlands) approved this study (MREC number: 201900309). The study results will be made available to patients, GPs, paediatricians and laboratories via peer-reviewed publications and in presentations at (inter)national conferences. TRIAL REGISTRATION NUMBER The Netherlands Trial Register: NL7690 (Pre-results).
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Affiliation(s)
- Sophie Ansems
- General Practice and Elderly Care Medicine, University Medical Centre Groningen, Groningen, The Netherlands
| | - Marjolein Berger
- General Practice and Elderly Care Medicine, University Medical Centre Groningen, Groningen, The Netherlands
| | - Patrick van Rheenen
- Paediatric Gastroenterology, University Medical Centre Groningen Beatrix Childrens Hospital, Groningen, The Netherlands
| | - Karin Vermeulen
- Epidemiology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Gina Beugel
- General Practice and Elderly Care Medicine, University Medical Centre Groningen, Groningen, The Netherlands
| | - Maria Couwenberg
- General Practice and Elderly Care Medicine, University Medical Centre Groningen, Groningen, The Netherlands
| | - Gea Holtman
- General Practice and Elderly Care Medicine, University Medical Centre Groningen, Groningen, The Netherlands
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Cui M, Pang G, Zhang T, Sun T, Zhang L, Kang R, Xue X, Pan H, Yang C, Zhang X, Chang J, Liu J, Zhang S, Wang H. Optotheranostic Nanosystem with Phone Visual Diagnosis and Optogenetic Microbial Therapy for Ulcerative Colitis At-Home Care. ACS NANO 2021; 15:7040-7052. [PMID: 33819424 DOI: 10.1021/acsnano.1c00135] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Ulcerative colitis (UC) is a relapsing disorder characterized by chronic inflammation of the intestinal tract. However, the home care of UC based on remote monitoring, due to the operational complexity and time-consuming procedure, restrain its widespread applications. Here we constructed an optotheranostic nanosystem for self-diagnosis and long-acting mitigations of UC at home. The system included two major modules: (i) A disease prescreening module mediated by smartphone optical sensing. (ii) Disease real-time intervention module mediated by an optogenetic engineered bacteria system. Recombinant Escherichia coli Nissle 1917 (EcN) secreted interleukin-10 (IL-10) could downregulate inflammatory cascades and matrix metalloproteinases; it is a candidate for use in the therapeutic intervention of UC. The results showed that the Detector was able to analyze, report, and share the detection results in less than 1 min, and the limit of detection was 15 ng·mL-1. Besides, the IL-10-secreting EcN treatment suppressed the intestinal inflammatory response in UC mice and protected the intestinal mucosa against injury. The optotheranostic nanosystems enabled solutions to diagnose and treat disease at home, which promotes a mobile health service development.
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Affiliation(s)
- Meihui Cui
- School of Life Sciences, Tianjin University, 92 Weijin Road, Nankai District, Tianjin 300072, China
| | - Gaoju Pang
- School of Life Sciences, Tianjin University, 92 Weijin Road, Nankai District, Tianjin 300072, China
| | - Tao Zhang
- School of Electrical and Information Engineering, Tianjin University, 92 Weijin Road, Nankai District, Tianjin 300072, China
| | - Tao Sun
- Center for Biosafety Research and Strategy, Tianjin University, 92 Weijin Road, Nankai District, Tianjin 300072, China
- School of Chemical Engineering and Technology, Laboratory of Synthetic Microbiology, Tianjin University, 135 Yaguan Road, Jinnan District, Tianjin 300350, China
| | - Lili Zhang
- School of Life Sciences, Tianjin University, 92 Weijin Road, Nankai District, Tianjin 300072, China
| | - Ruru Kang
- School of Life Sciences, Tianjin University, 92 Weijin Road, Nankai District, Tianjin 300072, China
| | - Xin Xue
- School of Life Sciences, Tianjin University, 92 Weijin Road, Nankai District, Tianjin 300072, China
| | - Huizhuo Pan
- School of Life Sciences, Tianjin University, 92 Weijin Road, Nankai District, Tianjin 300072, China
| | - Chun Yang
- School of Life Sciences, Tianjin University, 92 Weijin Road, Nankai District, Tianjin 300072, China
| | - Xinyu Zhang
- School of Life Sciences, Tianjin University, 92 Weijin Road, Nankai District, Tianjin 300072, China
| | - Jin Chang
- School of Life Sciences, Tianjin University, 92 Weijin Road, Nankai District, Tianjin 300072, China
| | - Jing Liu
- School of Life Sciences, Tianjin University, 92 Weijin Road, Nankai District, Tianjin 300072, China
| | - Shufang Zhang
- School of Electrical and Information Engineering, Tianjin University, 92 Weijin Road, Nankai District, Tianjin 300072, China
| | - Hanjie Wang
- School of Life Sciences, Tianjin University, 92 Weijin Road, Nankai District, Tianjin 300072, China
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Freeman K, Taylor-Phillips S, Willis BH, Ryan R, Clarke A. Test accuracy of faecal calprotectin for inflammatory bowel disease in UK primary care: a retrospective cohort study of the IMRD-UK data. BMJ Open 2021; 11:e044177. [PMID: 33619196 PMCID: PMC7903095 DOI: 10.1136/bmjopen-2020-044177] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 11/12/2020] [Accepted: 02/08/2021] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To estimate the test accuracy of faecal calprotectin (FC) for inflammatory bowel disease (IBD) in the primary care setting using routine electronic health records. DESIGN Retrospective cohort test accuracy study. SETTING UK primary care. PARTICIPANTS 5970 patients (≥18 years) without a previous IBD diagnosis and with a first FC test between 1 January 2006 and 31 December 2016. We excluded multiple tests and tests without numeric results in units of µg/g. INTERVENTION FC testing for the diagnosis of IBD. Disease status was confirmed by a recorded diagnostic code and/or a drug code of an IBD-specific medication at three time points after the FC test date. MAIN OUTCOME MEASURES Sensitivity, specificity, and positive and negative predictive values for the differential of IBD versus non-IBD and IBD versus irritable bowel syndrome (IBS) at the 50 and 100 µg/g thresholds. RESULTS 5970 patients met the inclusion criteria and had at least 6 months of follow-up data after FC testing. 1897 had an IBS diagnosis, 208 had an IBD diagnosis, 31 had a colorectal cancer diagnosis, 80 had more than one diagnosis and 3754 had no subsequent diagnosis. Sensitivity, specificity, and positive and negative predictive values were 92.9% (88.6% to 95.6%), 61.5% (60.2% to 62.7%), 8.1% (7.1% to 9.2%) and 99.6% (99.3% to 99.7%), respectively, at the threshold of 50 µg/g. Raising the threshold to 100 µg/g missed less than 7% additional IBD cases. Longer follow-up had no effect on test accuracy. Overall, uncertainty was greater for specificity than sensitivity. General practitioners' (GPs') referral decisions did not follow the anticipated clinical pathways in national guidance. CONCLUSIONS GPs can be confident in excluding IBD on the basis of a negative FC test in a population with low pretest risk but should interpret a positive test with caution. The applicability of national guidance to general practice needs to be improved.
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Affiliation(s)
| | | | - Brian H Willis
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Ronan Ryan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Aileen Clarke
- Warwick Medical School, University of Warwick, Coventry, UK
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5
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Walker GJ, Chanchlani N, Thomas A, Lin S, Moore L, Heerasing NM, Hendy P, Abdelrahim M, Mole S, Perry MH, Mcdonald TJ, Bewshea CM, Hart JW, Russell RK, Ahmad T, Goodhand JR, Kennedy NA. Primary care faecal calprotectin testing in children with suspected inflammatory bowel disease: a diagnostic accuracy study. Arch Dis Child 2020; 105:957-963. [PMID: 32424002 DOI: 10.1136/archdischild-2019-317823] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 03/04/2020] [Accepted: 04/03/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To determine the diagnostic accuracy of calprotectin to diagnose inflammatory bowel disease (IBD) in children in whom general practitioners (GPs) suspected IBD. DESIGN Prospective observational cohort study of a new calprotectin-based primary care referral pathway. SETTING 48 GP practices and gastroenterology secondary care services at the Royal Devon and Exeter NHS Foundation Trust in the South-West of England, UK. PATIENTS 195 children aged between 4 and 18 years referred on the pathway between January 2014 and August 2017 for investigation of gastrointestinal symptoms were included. INTERVENTIONS Primary-care-driven faecal calprotectin testing. Primary and secondary care records over 12 months from the point of calprotectin testing were used as the reference standard. MAIN OUTCOME MEASURES Diagnostic accuracy of calprotectin testing to detect IBD. RESULTS 7% (13/195) tested patients were diagnosed with IBD. Using our prespecified cut-off of 100 µg/g, calprotectin had a diagnostic accuracy of 91% (95% CI 86% to 95%) with a sensitivity for distinguishing IBD from non-IBD of 100% (95% CI 75% to 100%), a specificity of 91% (95% CI 85% to 94%), a positive predictive value of 43% (95% CI 25% to 63%) and a negative predictive value of 100% (95% CI 98% to 100%). Calprotectin testing had no effect on the time to diagnosis, but a negative test contributed to saved referrals and was associated with fewer diagnostic tests in secondary care. CONCLUSIONS Calprotectin testing of children with suspected IBD in primary care accurately distinguishes IBD from a functional gut disorder, reduces secondary care referrals and associated diagnostic healthcare utilisation.
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Affiliation(s)
- Gareth J Walker
- Gastroenterology, Royal Devon and Exeter Hospital, Exeter, UK.,Exeter IBD Pharmacogenetics, University of Exeter Medical School, Exeter, UK
| | - Neil Chanchlani
- Exeter IBD Pharmacogenetics, University of Exeter Medical School, Exeter, UK.,Paediatrics, Royal Devon and Exeter Hospital, Exeter, UK
| | - Amanda Thomas
- Gastroenterology, Royal Devon and Exeter Hospital, Exeter, UK.,Exeter IBD Pharmacogenetics, University of Exeter Medical School, Exeter, UK
| | - Simeng Lin
- Gastroenterology, Royal Devon and Exeter Hospital, Exeter, UK.,Exeter IBD Pharmacogenetics, University of Exeter Medical School, Exeter, UK
| | - Lucy Moore
- The College of Medicine & Health, University of Exeter, Exeter, UK
| | - Neel M Heerasing
- Gastroenterology, Royal Devon and Exeter Hospital, Exeter, UK.,Exeter IBD Pharmacogenetics, University of Exeter Medical School, Exeter, UK
| | - Peter Hendy
- Gastroenterology, Royal Devon and Exeter Hospital, Exeter, UK.,Exeter IBD Pharmacogenetics, University of Exeter Medical School, Exeter, UK
| | | | - Sean Mole
- Gastroenterology, Royal Devon and Exeter Hospital, Exeter, UK
| | - Mandy H Perry
- Biochemistry, Royal Devon and Exeter Hospital, Exeter, UK
| | - Timothy J Mcdonald
- The College of Medicine & Health, University of Exeter, Exeter, UK.,Biochemistry, Royal Devon and Exeter Hospital, Exeter, UK
| | - Claire M Bewshea
- Exeter IBD Pharmacogenetics, University of Exeter Medical School, Exeter, UK
| | - James W Hart
- Paediatrics, Royal Devon and Exeter Hospital, Exeter, UK
| | - Richard K Russell
- Paediatric Gastroenterology, The Hospital For Sick Children, Edinburgh, UK
| | - Tariq Ahmad
- Gastroenterology, Royal Devon and Exeter Hospital, Exeter, UK.,Exeter IBD Pharmacogenetics, University of Exeter Medical School, Exeter, UK
| | - James R Goodhand
- Gastroenterology, Royal Devon and Exeter Hospital, Exeter, UK.,Exeter IBD Pharmacogenetics, University of Exeter Medical School, Exeter, UK
| | - Nicholas A Kennedy
- Gastroenterology, Royal Devon and Exeter Hospital, Exeter, UK .,Exeter IBD Pharmacogenetics, University of Exeter Medical School, Exeter, UK
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Viola A, Fontana A, Belvedere A, Scoglio R, Costantino G, Sitibondo A, Muscianisi M, Inferrera S, Bruno LM, Alibrandi A, Trifirò G, Fries W. Diagnostic accuracy of faecal calprotectin in a symptom-based algorithm for early diagnosis of inflammatory bowel disease adjusting for differential verification bias using a Bayesian approach. Scand J Gastroenterol 2020; 55:1176-1184. [PMID: 32838582 DOI: 10.1080/00365521.2020.1807599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Diagnostic delay in IBD is a major problem and diagnosis is frequently arrived when irreversible damage has already occurred. This study evaluated accuracy of faecal calprotectin (fCAL) integrated with diagnostic criteria for early diagnosis of IBD in a primary care setting. METHODS General practitioners (GPs) were trained to recognize alarm symptoms for IBD classified as major and minor criteria. Fulfilment of one major or at least two minor criteria was followed by free fCAL testing and a visit by an IBD specialist and follow-up over 12 months. All patients with positive fCAL testing, i.e., ≥70 μg/g underwent colonoscopy. The diagnostic accuracy of fCAL was estimated after adjusting for differential-verification bias following a Bayesian approach. RESULTS Thirty-four GPs participated in the study and 133 patients were tested for fCAL between July 2016 and August 2017. Positivity of fCAL was seen in 45/133 patients (34%) and a final IBD diagnosis was made in 10/45 (22%). According to the threshold of 70 μg/g, fCAL achieved a sensitivity of 74.8% (95%CI: 39.10-96.01%), a specificity of 70.4% (95%CI: 61.76-78.16%) and an overall diagnostic accuracy of 70.6% (95%CI: 61.04-78.37%). As for prognostic accuracy, despite positive predictive value being low, 21.9% (95%CI: 11.74-35.18%), the negative predictive value was definitely higher: 96.2% (95%CI: 84.96-99.51%). CONCLUSIONS fCAL with a threshold set at 70 μg/g seems to represent a potentially reliable negative test to be used in primary care settings for patients with symptoms suggestive of IBD.
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Affiliation(s)
- Anna Viola
- Department of Clinical and Experimental Medicine, Clinical Unit for Chronic Bowel Disorders, University of Messina, Messina, Italy
| | - Andrea Fontana
- Unit of Biostatistics, Fondazione IRCCS Casa Sollievo della Sofferenza, Foggia, Italy
| | | | - Riccardo Scoglio
- Italian Society of General Medicine (SIMG), Section Messina, Messina, Italy
| | - Giuseppe Costantino
- Department of Clinical and Experimental Medicine, Clinical Unit for Chronic Bowel Disorders, University of Messina, Messina, Italy
| | - Aldo Sitibondo
- Department of Clinical and Experimental Medicine, Clinical Unit for Chronic Bowel Disorders, University of Messina, Messina, Italy
| | - Marco Muscianisi
- Department of Clinical and Experimental Medicine, Clinical Unit for Chronic Bowel Disorders, University of Messina, Messina, Italy
| | - Santi Inferrera
- Italian Society of General Medicine (SIMG), Section Messina, Messina, Italy
| | - Lucia Maria Bruno
- Department of Clinical and Experimental Medicine, Clinical Unit for Chronic Bowel Disorders, University of Messina, Messina, Italy
| | | | - Gianluca Trifirò
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Walter Fries
- Department of Clinical and Experimental Medicine, Clinical Unit for Chronic Bowel Disorders, University of Messina, Messina, Italy
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Clore J, Dean S, Kumral AVW, Manthe E, Ertl S. Teenager With Abdominal Pain and Decreased Appetite. Pediatrics 2020; 145:peds.2019-2233. [PMID: 32350022 DOI: 10.1542/peds.2019-2233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/06/2020] [Indexed: 11/24/2022] Open
Abstract
A 16-year-old girl presented to her primary care physician with a one-month history of decreased appetite and abdominal pain. She had normal bowel movements and no vomiting, but her periumbilical pain limited her ability to finish most meals. She had gradual weight loss over the previous 2 years, and during the previous 4 years, she intermittently received counseling for depression after the loss of her mother. Her initial physical examination and laboratory evaluation were unremarkable. She was referred to a nutritionist, adolescent medicine, and pediatric gastroenterology. Her presentation evolved over time, which ultimately led to a definitive diagnosis.
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Affiliation(s)
- John Clore
- Department of Pediatrics, University of Virginia, Charlottesville, Virginia
| | - Shelly Dean
- Department of Pediatrics, University of Virginia, Charlottesville, Virginia
| | - Abigail V W Kumral
- Department of Pediatrics, University of Virginia, Charlottesville, Virginia
| | - Eva Manthe
- Department of Pediatrics, University of Virginia, Charlottesville, Virginia
| | - Serwa Ertl
- Department of Pediatrics, University of Virginia, Charlottesville, Virginia
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8
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Ho SSC, Ross M, Keenan JI, Day AS. Fecal Calprotectin in Combination With Standard Blood Tests in the Diagnosis of Inflammatory Bowel Disease in Children. Front Pediatr 2020; 8:609279. [PMID: 33748035 PMCID: PMC7973106 DOI: 10.3389/fped.2020.609279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 12/02/2020] [Indexed: 12/19/2022] Open
Abstract
Introduction: Fecal calprotectin (FC) is a useful non-invasive screening test but elevated levels are not specific to inflammatory bowel disease (IBD). The study aimed to evaluate the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of FC alone or FC in combination with other standard blood tests in the diagnosis of IBD. Methods: Children aged <17 years who had FC (normal range <50 μg/g) measured and underwent endoscopy over 33 months in Christchurch, New Zealand were identified retrospectively (consecutive sampling). Medical records were reviewed for patient final diagnoses. Results: One hundred and two children were included; mean age was 12.3 years and 53 were male. Fifty-eight (57%) of the 102 children were diagnosed with IBD: 49 with Crohn's disease, eight with ulcerative colitis and one with IBD-unclassified. FC of 50 μg/g threshold provided a sensitivity of 96.6% [95% confident interval (CI) 88.3-99.4%] and PPV of 72.7% (95% CI 61.9-81.4%) in diagnosing IBD. Two children with IBD however were found to have FC <50 μg/g. Sensitivity in diagnosing IBD was further improved to 98.3% (95% CI 90.7-99.1%) when including FC >50 μg/g or elevated platelet count. Furthermore, PPVs in diagnosing IBD improved when FC at various thresholds was combined with either low albumin or high platelet count. Conclusion: Although FC alone is a useful screening test for IBD, a normal FC alone does not exclude IBD. Extending FC to include albumin or platelet count may improve sensitivity, specificity, PPV and NPV in diagnosing IBD. However, prospective studies are required to validate this conclusion.
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Affiliation(s)
- Shaun S C Ho
- Department of Pediatrics, University of Otago, Christchurch, New Zealand
| | - Michael Ross
- Department of Pediatrics, University of Otago, Christchurch, New Zealand
| | | | - Andrew S Day
- Department of Pediatrics, University of Otago, Christchurch, New Zealand
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Abstract
Recurrent abdominal pain (RAP) in children is common, with most functional in origin. Colonoscopy has sometimes been performed to exclude pathology but its role is unclear. Our aim therefore was to assess the diagnostic yield and role of colonoscopy in these children. Retrospective review of consecutive colonoscopies in a tertiary pediatric hospital between November 2011 and October 2015 was undertaken. Only those with RAP as an indication for procedure were included. Chart review of patients with pain was undertaken to ensure they fulfilled Rome IV criteria. Patient demographics, indication for procedure, and adjunct preprocedure tests were noted. Statistical analyses were performed with SPSS software. A total of 652 colonoscopies were performed, of which 68 (10%) had abdominal pain as one of the indications, and was the sole indication in 15 (2%) patients. All 68 patients had preprocedure serum inflammatory markers measured and 53% (36/68) had stool calprotectin. Positive histology was found in 10% (7/68) including Crohn disease (n = 3), polyps (n = 2), and microscopic colitis (n = 2). The remaining 61 patients had normal colonoscopy and ileocolonic biopsies. Of the 36 patients 5 had raised fecal calprotectin, and all had abnormal histology. Serum inflammatory markers were raised in 4 patients and all also had abnormal calprotectin. No patient with isolated abdominal pain had positive histology. Rectal bleeding was the only associated indication to predict abnormal histology (P = 0.019). Colonoscopy is likely not warranted in children with RAP without bleeding, weight loss, or altered bowel habit. Fecal calprotectin is useful in helping predict positive findings.
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