Diagnostic strategies in children with chronic gastrointestinal symptoms in primary care

Abstract

Chronic or recurrent gastrointestinal symptoms are common presentations among children in primary care. Because symptoms of functional gastrointestinal disorders may be indistinguishable from inflammatory bowel disease (IBD), it is a diagnostic challenge for clinicians to differentiate between them accurately. Unnecessary referrals in children with functional gastrointestinal disorders need to be balanced against the risk of missing a child with IBD. Calprotectin is an inflammatory marker that can be measured in faeces by using a simple non-invasive test, but has never been evaluated in children presenting in primary care. The main objective of the thesis was to determine the diagnostic value of faecal calprotectin for IBD in children presenting with chronic gastrointestinal symptoms in primary care. The results showed that faecal calprotectin is a useful test for ruling out IBD in children with chronic gastrointestinal symptoms and alarm symptoms. Blood markers showed lower discriminative value than faecal calprotectin. The blood marker C-reactive protein had no added value to alarm symptoms in contrast to faecal calprotectin. A test strategy of performing faecal calprotectin when alarm symptoms had been identified was associated with a reduction in referrals without missing a child with IBD. Therefore, blood markers seem less valuable in selecting children who need referral to specialist care then faecal calprotectin. However, an impact study is now needed to determine whether the test strategy of faecal calprotectin and alarm symptoms might actually improve both the diagnostic decision making of general practitioners in daily practice and the cost-effectiveness of diagnostic assessment in primary care