New Algorithm For Sorting Out Child Abdominal Pains

Seemed so practical, have included algorithm

Clin Pediatr (Phila). 2019 Jan;58(1):79-87. doi: 10.1177/0009922818806317
Algorithm to Predict Which Children With Chronic Abdominal Pain Are Low Suspicion
for Significant Endoscopic Findings.
Mark JA et al
https://www.ncbi.nlm.nih.gov/pubmed/30306797

childabd_algorithm

  • Fecal calprotectin indirectly measure pus or neurophils in stools and indicates inflammatory bowel disease: Must be the upgraded stool leukocyte test…

Clinics (Sao Paulo). 2009 May;64(5):421-5.
The role of fecal calprotectin in investigating inflammatory bowel diseases.
Erbayrak M. et al
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2694246/pdf/cln64_5p421.pdf

Saskatchewan provincial lab instruction here:

patient collection instructions for fecal calprotectin

  • transglutamine immunoglobulin A (TTG) is part of the celiac screen used by provincial health. It is only maybe 50% sensitive as there are frequent cases of non-celiac gluten sensitivity around though I’m not sure how prevalent in children.
  • significant diarrhea would be 3 or more loose stools/day and/or nocturnal stooling waking from sleep
  • linear growth failure = decrease in 2 or more major height percentiles
  • significant weight loss  = decrease in 2 or more major percentiles AND body mass index <25th percentile
  • extraintestinal symptoms of IBD include recurrent oral/anal ulcers, uveitis, arthritis, pyoderma gangrenosum,  unexplained fevers
  • Helicobacter pylori   is thought not important unless actual peptic ulcers (gastritis a non-entity)
  • Eosinophilic esophagitis requires > 15 eosinophils/high-powered field on esophageal biopsy after >6 weeks on daily or twice daily proton pump inhibitor.

 

Comment – there is not only knwledge here, but wisdom as well and I hope it helps some cases

 

 

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