Faculty of Medicine, Cairo University, Cairo, Egypt.
Misr International University, Cairo, Egypt.
Arab J Gastroenterol. 2021 Mar;22(1):61-65. doi: 10.1016/j.ajg.2020.12.004. Epub 2021 Mar 2.
Biliary atresia (BA) is a major cause of hepatic failure and consequent liver transplantation in pediatrics. If BA is not diagnosed early and the proper surgical intervention is not performed before the age of 3 months, the survival of the affected infant is significantly reduced. In 1994, a stool color card (SCC) for early detection of BA was developed and used in Japan, a country where the parents' socioeconomic and education levels are high. We aimed to assess the value of using the SCC as a screening tool for early diagnosis of BA at a tertiary referral center in Egypt (a low/middle-income country).
This prospective study enrolled 108 infants (56 females) aged 1 day to 4 months who presented with cholestasis to the Hepatology Unit of Cairo University Children's Hospital from January 2018 to August 2019. In most of our patients, the mothers were the main caregivers and the parents' socioeconomic and education levels were generally modest or low. We utilized the SCC courtesy of the Perinatal Services BC (Vancouver, Canada) with an Arabic translation. This SCC contains nine colored stool photos: the first six are ranked as abnormal colors and the last three are ranked as normal.
We found that almost all referring physicians were unfamiliar with or unaware of the SCC concept. Twenty-six of our babies' mothers were illiterate and 36 had not completed their primary school education. In spite of this low education level, 43 mothers of babies who were finally confirmed to have BA correctly matched a stool color of BA on the SCC with their babies' stools, and 56 mothers of babies who were finally confirmed not to have BA correctly matched a stool color not of BA with their babies' stools. Only nine mothers made a wrong match. Therefore, the overall "lay" mothers' sensitivity and specificity in diagnosis of BA using the SCC were 93.48% (95% confidence interval [CI] 82.1%-98.63%) and 90.32% (95% CI 80.12%-96.37%), respectively.
To the best of our knowledge, this is the first study reporting the use of the SCC (with an Arabic translation) in a low/middle-income country. Despite the referring physicians' unfamiliarity with the SCC and the mothers' relatively low education level at our center; SCC proved to be a simple, efficient, highly sensitive, specific, and applicable method for early diagnosis of BA. Therefore, SCC screening might increase motherś (as well as physicianś) awareness of BA, and we recommend that it be more publicized and used as a mass neonatal screening tool in low/middle-income countries such as Egypt.
胆道闭锁（BA）是导致儿科患者肝衰竭和随后肝移植的主要原因。如果在 3 个月之前未早期诊断 BA 并进行适当的手术干预，受影响婴儿的存活率将显著降低。1994 年，日本开发了一种用于早期检测 BA 的粪便颜色卡（SCC），该国父母的社会经济和教育水平较高。我们旨在评估在埃及（中低收入国家）的三级转诊中心使用 SCC 作为 BA 早期诊断的筛查工具的价值。
本前瞻性研究纳入了 2018 年 1 月至 2019 年 8 月期间因胆汁淤积症就诊于开罗大学儿童医院肝病科的 108 名 1 天至 4 个月大的婴儿（56 名女性）。在我们的大多数患者中，母亲是主要照顾者，父母的社会经济和教育水平普遍中等或较低。我们使用了由卑诗省围产期服务机构（加拿大温哥华）提供的 SCC，并附有阿拉伯语翻译。该 SCC 包含九张彩色粪便照片：前六张被评为异常颜色，后三张被评为正常。
我们发现几乎所有的转诊医生都不熟悉或不知道 SCC 的概念。我们有 26 名婴儿的母亲是文盲，36 名母亲没有完成小学教育。尽管教育水平较低，但最终被确诊为 BA 的 43 名婴儿的母亲正确地将 SCC 上 BA 的粪便颜色与婴儿的粪便进行了匹配，最终被确诊为无 BA 的 56 名婴儿的母亲正确地将非 BA 的粪便颜色与婴儿的粪便进行了匹配。只有 9 位母亲出现了错误的匹配。因此，使用 SCC 进行 BA 诊断的“普通”母亲的总体敏感性和特异性分别为 93.48%（95%置信区间 [CI] 82.1%-98.63%）和 90.32%（95% CI 80.12%-96.37%）。
据我们所知，这是第一项在中低收入国家报告使用 SCC（附有阿拉伯语翻译）的研究。尽管我们中心的转诊医生不熟悉 SCC，母亲的教育水平相对较低，但 SCC 被证明是一种简单、高效、高度敏感、特异和适用的 BA 早期诊断方法。因此，SCC 筛查可能会提高母亲（以及医生）对 BA 的认识，我们建议在埃及等中低收入国家将其进一步推广并用作新生儿大规模筛查工具。
