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Red flags in children with chronic abdominal pain and Crohn's disease-a single center experience
Khalil El-Chammas1, Angela Majeskie, Pippa Simpson
1Division of Pediatric Gastroenterology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA.
Insights
Anemia, hematochezia, and weight loss are key indicators for identifying pediatric Crohn's disease (CD) in children with chronic abdominal pain (CAP). Other symptoms like waking from sleep or joint pain are not reliable red flags for CD.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Clinical Symptomatology
Background:
- Chronic abdominal pain (CAP) in children often requires differentiation from underlying organic diseases like Crohn's disease (CD).
- Established "red flag" symptoms for identifying pediatric CD lack validation, necessitating further research.
Purpose of the Study:
- To compare the presenting history and symptoms of pediatric patients with chronic abdominal pain (CAP) and Crohn's disease (CD).
- To identify reliable indicators for diagnosing CD in children presenting with abdominal pain.
Main Methods:
- Prospective data collection from 606 pediatric patients (2005-2008) in a specialized clinic.
- Comparison of patients with CAP (functional gastrointestinal disorders) and those with biopsy-confirmed CD.
- Analysis of demographic, history, and symptom questionnaires.
Main Results:
- Patients with functional gastrointestinal disorders reported more stressors and a family history of IBS, reflux, or constipation.
- Vomiting was more common in functional gastrointestinal disorders, while hematochezia, weight loss, and poor weight gain were less frequent.
- Anemia, hematochezia, and weight loss demonstrated a 94% cumulative sensitivity in predicting CD.
Conclusions:
- Anemia, hematochezia, and weight loss are crucial in identifying pediatric patients with CAP who need further evaluation for CD.
- Symptoms such as waking from sleep and joint pain were not significantly different between groups and should not be considered "red flags" for CD.
Objective:
To compare history and symptoms at initial presentation of patients with chronic abdominal pain (CAP) and Crohn's disease (CD). Red flags are used to help determine which patients with CAP are likely to have an underlying disease such as CD. However, red flags have not been validated and pediatric studies are lacking.
Study Design:
Patients seen in the outpatient Pediatric Gastroenterology Clinic at Children's Hospital of Wisconsin between 2005 and 2008 prospectively completed a demographic, history, and symptom questionnaire. Patients with abdominal pain for at least 1 month and no evidence of organic disease were compared with patients diagnosed with CD confirmed by mucosal biopsies.
Results:
Data were collected on 606 patients (128 with CD and 478 with functional gastrointestinal disorders). Patients with functional gastrointestinal disorders had more stressors (P < .001), were more likely to have a positive family history of irritable bowel syndrome, reflux, or constipation (P < .05), were more likely to have vomiting but less likely to have hematochezia, weight loss, and problems gaining weight (P < .05); wake from sleep and joint pain were no different between groups. Anemia, hematochezia, and weight loss were most predictive of CD (cumulative sensitivity of 94%).
Conclusion:
The presence of anemia, hematochezia, and weight loss help identify patients with CAP who require further work-up and referral to a pediatric gastroenterologist. Furthermore, waking from sleep or joint pain occurred similarly between groups and should not be considered as "red flags."
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