Comparing diagnostic strategies for IBD

When a child presents with abdominal pain and chronic nonbloody diarrhea, inflammatory bowel disease (IBD) would show up on the differential diagnosis. An investigation in Pediatrics evaluates 4 different strategies to find which ones are effective.¹

The investigators ran a prospective cohort study of children aged 6 to 18 years who were given a standardized diagnostic workup in a secondary or tertiary care hospital. Each participant was assessed for symptoms, C-reactive protein (>10 mg/L), hemoglobin, and fecal calprotectin (≥250 μg/g). Participants who had rectal bleeding or perianal disease were excluded from the study.

The cohort included 193 participants and 22 of them had IBD. The basic prediction model used symptoms only. The addition of blood and stool markers increased the area under curve from 0.718 to 0.930 and 0.967. When combined, symptoms, blood, and stool markers did better than all other strategies. Doing a triage with a strategy that includes symptoms, blood markers, and calprotectin will result in 14 of 100 patients undergoing endoscopy. Three of those who undergo endoscopy will not have IBD and no patient with IBD will be missed.

Investigators concluded that using symptoms, blood, and stool markers to diagnose patients with nonbloody diarrhea is the best strategy. Using this to diagnose will allow clinicians to use endoscopy only with children who are at high risk of IBD.

Reference

1. Van de Vijver E, Heida A, Ioannou S, et al. Test strategies to predict inflammatory bowel disease among children with nonbloody diarrhea. Pediatrics. July 21, 2020 Epub ahead of print. doi:10.1542/peds.2019-2235