Gea A Holtman1, Yvonne Lisman-van Leeuwen1, Boudewijn J Kollen1, Obbe F Norbruis2, Johanna C Escher3, Angelika Kindermann4, Yolanda B de Rijke5, Patrick F van Rheenen6, Marjolein Y Berger7. 1. Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. 2. Department of Pediatrics, Isala Hospital, Zwolle, The Netherlands. 3. Department of Pediatric Gastroenterology, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands. 4. Department of Pediatric Gastroenterology, Emma Children's Hospital ⁄ Academic Medical Center, Amsterdam, The Netherlands. 5. Department of Clinical Chemistry, Erasmus University Medical Centre, Rotterdam, The Netherlands. 6. Department of Pediatric Gastroenterology, Beatrix Children's Hospital ⁄ University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. 7. Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands m.y.berger@umcg.nl.
Abstract
PURPOSE: In specialist care, fecal calprotectin (FCal) is a commonly used noninvasive diagnostic test for ruling out inflammatory bowel disease (IBD) in children with chronic gastrointestinal symptoms. The aim of this study was to evaluate the diagnostic accuracy of FCal for IBD in symptomatic children in primary care. METHODS: We studied 2 prospective cohorts of children with chronic diarrhea, recurrent abdominal pain, or both: children initially seen in primary care (primary care cohort) and children referred to specialist care (referred cohort). FCal (index test) was measured at baseline and compared with 1 of the 2 reference standards for IBD: endoscopic assessment or 1-year follow-up. Physicians were blinded to FCal results, and values greater than 50 μg/g feces were considered positive. We determined specificity in the primary care cohort and sensitivity in the referred cohort. RESULTS: None of the 114 children in the primary care cohort ultimately received a diagnosis of IBD. The specificity of FCal in the primary care cohort was 0.87 (95% CI, 0.80-0.92). Among the 90 children in the referred cohort, 17 (19%) ultimately received a diagnosis of IBD. The sensitivity of FCal in the referred cohort was 0.99 (95% CI, 0.81-1.00). CONCLUSIONS: The findings of this study suggest that a positive FCal result in children with chronic gastrointestinal symptoms seen in primary care is not likely to be indicative of IBD. A negative FCal result is likely to be a true negative, which safely rules out IBD in children in whom a primary care physician considers referral to specialist care.
PURPOSE: In specialist care, fecal calprotectin (FCal) is a commonly used noninvasive diagnostic test for ruling out inflammatory bowel disease (IBD) in children with chronic gastrointestinal symptoms. The aim of this study was to evaluate the diagnostic accuracy of FCal for IBD in symptomatic children in primary care. METHODS: We studied 2 prospective cohorts of children with chronic diarrhea, recurrent abdominal pain, or both: children initially seen in primary care (primary care cohort) and children referred to specialist care (referred cohort). FCal (index test) was measured at baseline and compared with 1 of the 2 reference standards for IBD: endoscopic assessment or 1-year follow-up. Physicians were blinded to FCal results, and values greater than 50 μg/g feces were considered positive. We determined specificity in the primary care cohort and sensitivity in the referred cohort. RESULTS: None of the 114 children in the primary care cohort ultimately received a diagnosis of IBD. The specificity of FCal in the primary care cohort was 0.87 (95% CI, 0.80-0.92). Among the 90 children in the referred cohort, 17 (19%) ultimately received a diagnosis of IBD. The sensitivity of FCal in the referred cohort was 0.99 (95% CI, 0.81-1.00). CONCLUSIONS: The findings of this study suggest that a positive FCal result in children with chronic gastrointestinal symptoms seen in primary care is not likely to be indicative of IBD. A negative FCal result is likely to be a true negative, which safely rules out IBD in children in whom a primary care physician considers referral to specialist care.
Authors: Els Van de Vijver; Andrea Bertilde Schreuder; Wybrich Riemke Cnossen; Anna Caecilia Muller Kobold; Patrick Ferry van Rheenen Journal: Arch Dis Child Date: 2012-09-27 Impact factor: 3.791
Authors: B Starfield; R A Hoekelman; M McCormick; P Benson; R C Mendenhall; C Moynihan; S Radecki Journal: Pediatrics Date: 1984-12 Impact factor: 7.124
Authors: David R Mack; Christine Langton; James Markowitz; Neal LeLeiko; Anne Griffiths; Athos Bousvaros; Jonathan Evans; Subra Kugathasan; Anthony Otley; Mariann Pfefferkorn; Joel Rosh; Adam Mezoff; Susan Moyer; Maria Oliva-Hemker; Robert Rothbaum; Robert Wyllie; J Fernando delRosario; David Keljo; Trudy Lerer; Jeffrey Hyams Journal: Pediatrics Date: 2007-06 Impact factor: 7.124
Authors: Gea A Holtman; Yvonne Lisman-van Leeuwen; Boudewijn J Kollen; Johanna C Escher; Angelika Kindermann; Patrick F van Rheenen; Marjolein Y Berger Journal: BMC Fam Pract Date: 2013-11-25 Impact factor: 2.497
Authors: Eliza Lężyk-Ciemniak; Magdalena Tworkiewicz; Dominika Wilczyńska; Anna Szaflarska-Popławska; Aneta Krogulska Journal: Med Princ Pract Date: 2020-10-29 Impact factor: 1.927
Authors: Gea A Holtman; Yvonne Lisman-van Leeuwen; Andrew S Day; Ulrika L Fagerberg; Paul Henderson; Stevan T Leach; Gøri Perminow; David Mack; Patrick F van Rheenen; Els van de Vijver; David C Wilson; Johannes B Reitsma; Marjolein Y Berger Journal: JAMA Pediatr Date: 2017-10-01 Impact factor: 26.796
Authors: Anke Heida; Els Van de Vijver; Don van Ravenzwaaij; Stephanie Van Biervliet; Thalia Z Hummel; Zehre Yuksel; Gieneke Gonera-de Jong; Renate Schulenberg; Anneke Muller Kobold; Patrick Ferry van Rheenen Journal: Arch Dis Child Date: 2018-03-07 Impact factor: 3.791
Authors: Elsa A van Wassenaer; Kay Diederen; Ester M M van Leeuwen; Geert R D'Haens; Marc A Benninga; Bart G P Koot; Angelika Kindermann Journal: J Clin Gastroenterol Date: 2022-01-01 Impact factor: 3.062
Authors: Gea A Holtman; Yvonne Lisman-van Leeuwen; Boudewijn J Kollen; Obbe F Norbruis; Johanna C Escher; Laurence C Walhout; Angelika Kindermann; Yolanda B de Rijke; Patrick F van Rheenen; Marjolein Y Berger Journal: PLoS One Date: 2017-12-06 Impact factor: 3.240
Authors: Corinne Chmiel; Oliver Senn; Susann Hasler; Thomas Rosemann; Gerhard Rogler; Nadine Zahnd; Ryan Tandjung; Nathalie Scherz; Michael Christian Sulz; Stephan Vavricka Journal: PLoS One Date: 2019-11-21 Impact factor: 3.240