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Chronic Abdominal Pain and IBD

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Checked: 23-05-2020 by Vicky Ryan Next Review: 23-05-2021

Clinical Guidelines

Refer to the Abdominal Pain (Chronic) in Children document provided by Bristol Royal Hospital for Children.

These guidelines include assessment and investigation of abdominal symptoms in children over 3yo.

Advice on investigation of suspected coeliac disease and when to refer are also included.

Referral

If further advice is required then consider using the Paediatric Advice and Guidance Service

Refer immediately or urgently to general paediatrics if alarm symptoms or abnormal test results (see red flags)

Refer to paediatric gastroenterologist via ereferral if positive coeliac screen or investigations strongly suggestive of IBD (especially if positive family history and/or raised faecal calprotectin).

Red Flags

Alarm symptoms and signs associated with a higher prevalence of organic disease:

Involuntary weight loss/failure to thrive
Gastrointestinal bleeding
Chronic, persistent diarrhoea or vomiting
Persistent right upper quadrant or right lower quadrant abdominal pain
Unexplained fever
Family history of inflammatory bowel disease (IBD)
Jaundice
Urinary symptoms, back or flank pain
Abnormal examination findings
Faecal calprotectin >200 ug/g

Faecal Caprotectin in children

Information about faecal calprotectin is contained in the BRHC guidelines (see link above)

To summarise

When to test faecal Calprotectin?

Consider testing calprotectin in children with recurrent abdominal pain, unformed and frequent (non-bloody) stools when an infective problem has been excluded in order to rule out Inflammatory Bowel Disease.

When not to test faecal Calprotectin?

Children with colitis – frequent, loose, bloody stools associated with abdominal pain do not require calprotectin testing. Once an infective aetiology has been excluded they should be referred direct to paediatric gastroenterology for endoscopic evaluation

Infants and children aged less than four years of age should not have calprotectin tested. Normal laboratory reference values have not been validated. Inflammatory Bowel Disease in this young age group invariably presents as colitis.

How to interpret the faecal Calprotectin result?

• If Calprotectin <100 micrograms/g – Inflammatory Bowel Disease is unlikely. Reassure family and reassess symptoms in six weeks. If evidence of symptom escalation consider repeat test.

• If Calprotectin 100 to 200 micrograms/g – Inflammatory Bowel Disease is still unlikely but is possible. Ensure no intake of Non-Steroidal Anti-Inflammatory Drugs (cause false positive result). Repeat Calprotectin test within one month and also check FBC, LFT, CRP/ESR. Refer to paediatric gastroenterology rapid access clinic for assessment if repeat calprotectin is >100 micrograms/g and evidence of systemic inflammation (raised platelets/CRP/ESR, low albumin)

• If Calprotectin >200 micrograms/g – Inflammatory Bowel Disease is possible – refer to paediatric gastroenterology rapid access clinic for assessment.

Functional Gastro-intestinal Disorders

If a functional bowel disorder is diagnosed then the following parent information leaflet may be helpful:

What are functional gastro-intestinal disorders?

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