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Safely ruling out inflammatory bowel disease in children and teenagers without referral for endoscopy
Els Van de Vijver1, Andrea Bertilde Schreuder, Wybrich Riemke Cnossen
1Department of Paediatric Gastroenterology, Antwerp University Hospital, Wilrijkstraat 10, Edegem, Belgium. els.van.de.vijver@uza.be
Insights
Using faecal calprotectin testing alongside clinical assessment significantly improves the accuracy of diagnosing inflammatory bowel disease (IBD) in children. This approach reduces unnecessary referrals to specialists, ensuring timely diagnosis for those who truly have IBD.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Accuracy Studies
- Inflammatory Bowel Disease (IBD) Research
Background:
- Up to 70% of pediatric referrals for suspected inflammatory bowel disease (IBD) are ultimately negative.
- This high rate of non-IBD cases leads to significant healthcare resource utilization.
Purpose of the Study:
- To determine if faecal calprotectin testing as an add-on diagnostic tool enhances the specificity of clinical case definitions for suspected IBD in general pediatric practice.
- To reduce unnecessary referrals to specialized gastroenterology centers.
Main Methods:
- A prospective diagnostic accuracy study was conducted across six general pediatric outpatient clinics and one tertiary care hospital.
- 117 children and teenagers with suspected IBD underwent faecal calprotectin testing.
- Endoscopy served as the reference standard for diagnosis, with a subset of patients also monitored via clinical follow-up.
Main Results:
- Of the 117 participants (mean age 14 years), 42 (36%) were confirmed to have IBD.
- Paediatricians, blinded to faecal calprotectin results, referred 68 patients for endoscopy.
- Utilizing a positive faecal calprotectin result (>50 μg/g) would have led to 54 referrals, indicating improved specificity.
Conclusions:
- A diagnostic strategy combining a clinical case definition with positive faecal calprotectin results increases IBD detection specificity in general pediatrics.
- This approach effectively reduces the need for referrals to pediatric gastroenterology centers.
- The study suggests a low risk of missing IBD cases with this combined strategy.
Background:
Up to 70% of children and teenagers referred to a paediatric gastroenterology centre with suspected inflammatory bowel disease (IBD) do not have the disease.
Objective:
To evaluate whether faecal calprotectin as an 'add-on test' improves the specificity of the clinical case definition for suspected IBD in a general paediatric practice.
Design:
A prospective diagnostic accuracy study.
Setting:
Six outpatient clinics for general paediatrics and one tertiary care hospital in the Netherlands.
Patients:
117 children and teenagers with a clinical suspicion of IBD.
Diagnostic Tests:
Faecal calprotectin was measured (index test) in all patients. Patients with a high index of suspicion on the basis of the paediatrician's global assessment, physical examination and blood results were referred for endoscopy (reference standard). Children and teenagers who were not selected for endoscopy initially were followed for half a year for the appearance of possible additional symptoms (delayed type reference standard).
Primary Outcome:
The proportion of referred patients with confirmed IBD.
Results:
The mean age of patients was 14 years (range 6-18). A total of 42 (36%) had confirmed IBD. The paediatricians, who were blinded to the faecal calprotectin result, referred 68 children and teenagers for endoscopy. If they had referred only those patients with a positive faecal calprotectin result (>50 μg/g), 54 patients would have undergone endoscopy.
Limitation:
The study relied on clinical follow-up to detect missed IBD.
Conclusions:
A diagnostic strategy in general paediatric practice of using a simple clinical case definition for suspected IBD in combination with a positive faecal calprotectin result increases the specificity to detect IBD and reduces the need for referral to a paediatric gastroenterology centre with a very low risk of missing cases.
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