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Use of stool color card as screening tool for biliary atresia in resource-constraint country

Rubaiyat Alam1, Khan Lamia Nahid1, Md Omar Faruk1

  • 1Department of Pediatric Gastroenterology and Nutrition, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.

Gastroenterology and Hepatology From Bed to Bench
|July 12, 2024
PubMed

Insights

A stool color card (SCC) effectively screens for biliary atresia (BA) in infants, showing high sensitivity. While not perfectly specific, the SCC is a valuable tool for early detection and referral in resource-limited settings.

Area of Science:

  • Pediatric Gastroenterology
  • Neonatalaundice Diagnosis
  • Public Health Screening Tools

Background:

  • Biliary atresia (BA) diagnosis is critical for infant health.
  • Early detection of BA significantly improves treatment outcomes.
  • Resource-limited settings require accessible diagnostic tools for BA.

Purpose of the Study:

  • To evaluate the efficacy of a stool color card (SCC) for differentiating biliary atresia (BA) from non-BA.
  • To assess the diagnostic performance of SCC in resource-limited environments.
  • To determine the utility of SCC as an early screening tool for BA.

Main Methods:

  • Cross-sectional observational study conducted from January 2019 to July 2022.
  • Inclusion criteria: infants <3 months with jaundice, direct bilirubin >20%, pale stool, and dark urine.
  • 144 infants were sampled, with BA confirmed in 106 (73.6%) and non-BA in 38 (26.4%).

Main Results:

  • Persistent pale stool was significantly more frequent in BA (83.0%) versus non-BA (21.0%) infants (p=0.000).
  • Serum gamma-glutamyl transpeptidase (GGT) levels were significantly higher in BA (570 U/L) compared to non-BA (138.0 U/L) (p=0.000).
  • The stool color card (SCC) demonstrated a sensitivity of 83%, specificity of 78.9%, and accuracy of 81.9% for BA diagnosis.

Conclusions:

  • The stool color card (SCC) exhibits good sensitivity for diagnosing biliary atresia (BA).
  • SCC's specificity is insufficient for sole reliance, but it serves as an effective early screening tool.
  • Prompt referral based on SCC screening can facilitate timely evaluation and management of BA.
Abstract

Keywords:
Biliary atresiaCholestasisKasai ProcedureStool color card

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