■当患有慢性胃肠道(GI)症状的儿童出现在初级保健医师或普通儿科医生面前时,临床医生面临着区分功能性或器质性疾病的挑战。当高度怀疑炎症性肠病(IBD)时,快速转诊至儿科胃肠病学家进行评估和治疗将有助于防止儿童延迟诊断的后遗症。然而,这必须与确保适当转诊和避免对非器质性病因患者进行侵入性诊断测试的需要相平衡.这篇叙述性综述的目的是提供具体症状的证据,测试,和儿科IBD的危险因素,可能有助于识别需要及时转诊专科护理的儿童,从而减少延迟诊断的机会。
■文献数据库(Medline,Embase)使用特定于研究人群的术语进行搜索,以及与评论的每个部分相关的特定主题术语。设定了2010-2022年的年份限制。包括的论文仅限于原始研究,荟萃分析考虑了获益的地方。
■儿童常出现非特异性胃肠道症状,这可能与随后IBD的延迟诊断有关。直肠出血或体重减轻等症状可能表明需要快速转诊。然而,非特异性症状需要检测策略来区分可能患有IBD和非器质性疾病的患者.目前尚无法对IBD进行明确的实验室检测。这篇综述概述了应该考虑和监控的指标,然后用于全面转诊至三级护理,以进行专科儿科胃肠病学检查。提供了与出现症状有关的摘要,肠外表现(EIM),和警报症状,以突出显示最常报告的症状。解释粪便钙卫蛋白(FC)水平的诊断准确性和重要性,结合其他措施,也概述了。
■在不需要内窥镜检查的情况下有效识别IBD儿童的诊断测试尚不可用。初级保健医生和普通儿科医生必须,因此,依靠解释症状的组合,实验室参数,和风险因素,以评估是否需要专科转诊和诊断。
UNASSIGNED: When a child with chronic gastrointestinal (GI) symptoms presents to a primary care physician or general paediatrician, the clinician is challenged with differentiating between functional or organic disease. When there is a high suspicion of inflammatory bowel disease (IBD), rapid referral to a paediatric gastroenterologist for assessment and treatment will help protect against the sequelae of a delayed diagnosis for a child. However, this must be balanced against the need for ensuring appropriate referrals and avoiding invasive diagnostic testing for those with non-organic aetiology. The objective of this narrative
review was to present evidence on specific presenting symptoms, testing, and risk factors of paediatric IBD that may aid the identification of children requiring timely referral for specialist care, thereby reducing the chance of a delayed diagnosis.
UNASSIGNED: Literature databases (Medline, Embase) were searched using terms specific to the population studied, and topic specific terms relating to each section of the
review. Year limits were set for 2010-2022. Included papers were limited to original research, with meta-analyses considered where of benefit.
UNASSIGNED: Children often present with non-specific GI symptoms that may be associated with a delayed diagnosis for those with subsequent IBD. Symptoms such as rectal bleeding or weight loss may indicate the need for rapid referral. However, non-specific symptoms necessitate testing strategies to differentiate between those with possible IBD and non-organic conditions. Definitive laboratory testing for IBD is not yet available. This
review outlines those metrics that should be considered and monitored, then utilised to make a comprehensive referral to tertiary care for specialist paediatric gastroenterology
review. Summaries are provided relating to presenting symptoms, extra-intestinal manifestations (EIMs), and alarm symptoms in order to highlight those reported most frequently. The diagnostic accuracy and importance of interpreting faecal calprotectin (FC) levels, in conjunction with additional measures, are also outlined.
UNASSIGNED: Diagnostic testing to effectively identify children with IBD without the need for endoscopy is not yet available. Primary care physicians and general paediatricians must, therefore, rely on interpreting a combination of symptoms, laboratory parameters, and risk factors to assess the need for specialist referral and diagnosis.