Abstract
Objectives. The aim of the study was to establish whether fecal calprotectin concentration (FCC) may be useful in children with chronic abdominal pain to differentiate between inflammatory bowel disease (IBD), other inflammatory gastrointestinal disorders, and functional gastrointestinal disorders. Methods. The study included 163 patients (median age 13 years), who were assigned to four study groups: group 0 (control), 22 healthy children; group 1, 33 children with functional gastrointestinal disorders; group 2, 71 children with inflammatory gastrointestinal disorders other than IBD; group 3, 37 children with IBD. FCC was measured using ELISA assay. Results. In group 0 and group 1 FCCs were below 100 μg/g. Low FCCs were found in 91% of patients in group 2. In patients with IBD FCCs were markedly elevated with median value of 1191.5 μg/g. However, in children with inflammatory gastrointestinal disorders other than IBD and in children with IBD mean FCCs were significantly higher compared with the control group. Significant differences in FCCs were also found between group 1 and group 2, between group 1 and group 3, and between group 2 and group 3. Conclusion. FCC is the best parameter allowing for differentiation between IBD, other inflammatory gastrointestinal disorders, and functional gastrointestinal disorders. High FCC is associated with a high probability of IBD and/or other inflammatory gastrointestinal disorders, and it allows excluding functional gastrointestinal disorders.
Highlights
Chronic abdominal pain in children is a very frequent and sometimes challenging diagnostic issue
Differential diagnosis of chronic abdominal pain should include disorders of the gastrointestinal system causing inflammatory changes in the gastrointestinal tract, and diseases of other organs and tissues that are not related to the gastrointestinal system but are located in the abdomen
Group 3 consisted of patients with inflammatory bowel disease (IBD) diagnosed according to the Porto criteria [32]
Summary
Chronic abdominal pain in children is a very frequent and sometimes challenging diagnostic issue. Abdominal pain may be constant or intermittent of variable severity and locations. Differential diagnosis of chronic abdominal pain should include disorders of the gastrointestinal system (e.g., gastritis and/or duodenitis, pancreatitis, hepatitis, inflammatory bowel disease, celiac disease, food allergy, or gastrointestinal infection) causing inflammatory changes in the gastrointestinal tract, and diseases of other organs and tissues that are not related to the gastrointestinal system but are located in the abdomen (e.g., urinary tract infection, urolithiasis, and gynecological infections). In children over one year of age the most frequent functional gastrointestinal disorders include functional abdominal pain, functional abdominal pain syndrome, irritable bowel syndrome, abdominal migraine, and functional dyspepsia [2]
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