Department of Paediatric Gastroenterology, Hepatology, and Nutrition, University Hospital Antwerp, Edegem, Belgium;
Departments of General Practice.
Pediatrics. 2020 Aug;146(2). doi: 10.1542/peds.2019-2235. Epub 2020 Jul 21.
We evaluated 4 diagnostic strategies to predict the presence of inflammatory bowel disease (IBD) in children who present with chronic nonbloody diarrhea and abdominal pain.
We conducted a prospective cohort study including 193 patients aged 6 to 18 years who underwent a standardized diagnostic workup in secondary or tertiary care hospitals. Each patient was assessed for symptoms, C-reactive protein (>10 mg/L), hemoglobin (<-2 SD for age and sex), and fecal calprotectin (≥250 μg/g). Patients with rectal bleeding or perianal disease were excluded because the presence of these findings prompted endoscopy regardless of their biomarkers. Primary outcome was IBD confirmed by endoscopy or IBD ruled out by endoscopy or uneventful clinical follow-up for 6 months.
Twenty-two of 193 (11%) children had IBD. The basic prediction model was based on symptoms only. Adding blood or stool markers increased the AUC from 0.718 (95% confidence interval [CI]: 0.604-0.832) to 0.930 (95% CI: 0.884-0.977) and 0.967 (95% CI: 0.945-0.990). Combining symptoms with blood and stool markers outperformed all other strategies (AUC 0.997 [95% CI: 0.993-1.000]). Triaging with a strategy that involves symptoms, blood markers, and calprotectin will result in 14 of 100 patients being exposed to endoscopy. Three of them will not have IBD, and no IBD-affected child will be missed.
Evaluating symptoms plus blood and stool markers in patients with nonbloody diarrhea is the optimal test strategy that allows pediatricians to reserve a diagnostic endoscopy for children at high risk for IBD.
我们评估了 4 种诊断策略，以预测出现慢性非血性腹泻和腹痛的儿童中炎症性肠病（IBD）的存在。
我们进行了一项前瞻性队列研究，纳入了 193 名年龄在 6 至 18 岁之间的患者，这些患者在二级或三级保健医院接受了标准化的诊断评估。每位患者均评估了症状、C 反应蛋白（>10mg/L）、血红蛋白（低于年龄和性别-2SD）和粪便钙卫蛋白（≥250μg/g）。排除有直肠出血或肛周疾病的患者，因为这些发现存在时无论生物标志物如何均会进行内镜检查。主要结局是通过内镜检查确认的 IBD 或通过内镜检查排除的 IBD 或 6 个月无并发症的临床随访。
193 名儿童中有 22 名（11%）患有 IBD。基本预测模型仅基于症状。添加血液或粪便标志物可将 AUC 从 0.718（95%置信区间 [CI]：0.604-0.832）提高到 0.930（95% CI：0.884-0.977）和 0.967（95% CI：0.945-0.990）。将症状与血液和粪便标志物结合使用可优于所有其他策略（AUC 0.997[95% CI：0.993-1.000]）。采用包括症状、血液标志物和钙卫蛋白的策略进行分诊，将有 14 名 100 名患者接受内镜检查。其中 3 人不会患有 IBD，且不会漏诊任何患有 IBD 的儿童。
评估非血性腹泻患者的症状加血液和粪便标志物是最佳的测试策略，可使儿科医生将诊断性内镜检查保留给患有 IBD 高危儿童。
