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Noninvasive test at primary care level can rule out IBD in children

Among children with chronic gastrointestinal issues who may be considered for referral, a negative fecal calprotectin result is likely to be indicative of a true negative, sufficient to rule out inflammatory bowel disease at the primary care level, according to data published in the Annals of Family Medicine.

However, the researchers further noted that, in primary care, a positive result in fecal calprotectin (FCal) — a noninvasive test for ruling out inflammatory bowel disease (IBD) commonly used in specialist care — is not likely to lead to a diagnosis.

“According to guidelines, [PCPs] should refer children with chronic diarrhea, recurrent abdominal pain, or both for specialist care if red flags are present,” Gea A. Holtman, MSc, of the department of general practice at the University of Groningen, in the Netherlands, and colleagues wrote. “The red flags are nonspecific and discriminate poorly between functional and organic gastrointestinal diseases, often leading to referral and extensive diagnostic testing. For children with functional disorders, referral or extensive testing may delay appropriate interventions and further decrease well-being.”

To determine if FCal was accurate in diagnosing IBD in symptomatic children in primary care, the researchers examined two prospective cohorts of patients with chronic diarrhea, recurrent abdominal pain, or both. One cohort comprised 114 children initially seen in primary care, while the second included 90 who were referred to a specialist.

Researchers measured FCal at baseline and then compared it with endoscopic assessment or 1-year follow-up. The researchers then determined specificity in the primary care group, and sensitivity in the specialist group. FCal values of more than 50 µg/g feces were considered positive. Physicians were blinded to FCal results.

According to the researchers, none of the children in the primary care group would go on to receive an IBD diagnosis, and the specificity of FCal at the primary care level was 0.98 (95% CI, 0.8-0.92). In the specialist cohort, 19% received a diagnosis of IBD. The sensitivity of FCal in the specialist group was 0.99 (95% CI, 0.81-1).

“We found that, in selected children in whom a [PCP] considers a referral, FCal has satisfactory discriminatory power between children with and without IBD,” Holtman and colleagues wrote. “Of greater clinical relevance, however, is whether FCal can add to the diagnostic information that is readily available from a thorough history and physical examination. Moreover, the added value of commonly used blood markers should be compared with the added value of FCal. Further research is therefore needed to determine whether FCal should be incorporated into the routine diagnostic evaluation of pediatric patients with chronic gastrointestinal symptoms and red flags in primary care.” – by Jason Laday

Disclosure: The researchers report no relevant financial disclosures.