History |
Abdominal pain, appetite |
Stool frequency, consistency, rectal bleeding, nocturnal diarrhea |
Family history – Relatives with IBD, familial growth patterns |
Previous growth data* |
School attendance and daily activity |
Psychosocial history, including impact on daily life of patient and parent(s) |
Physical examination |
Height and weight, evaluating for trends and growth velocity* |
Abdominal examination – Tenderness, mass |
Rectal examination – Evaluate for perianal disease and occult blood |
Rash, arthritis, clubbing, oral lesions |
Sexual maturity staging (Tanner stage)* |
Laboratory tests |
CBC with differential count, platelets, ESR, CRP |
Serum total protein, albumin |
ALT, AST, GGTP (to assess for hepatobiliary disease, including primary sclerosing cholangitis) |
Stool for occult blood and calprotectin or lactoferrin; urine analysis |
Stool bacterial culture, ova and parasite testing, C. difficile testing |
Tuberculosis screening (interferon-gamma testing or tuberculin skin test)Δ |
Titers for varicella and measles; HBV serologiesΔ |
Additional tests as indicated, depending upon clinical findings:
|
Imaging |
For localization of small bowel disease, 1 of the following§:
|
Additional tests as indicated, depending on clinical findings – Bone age*, abdominal plain films, fistulogram or ultrasound |
Endoscopy |
Colonoscopy (including ileoscopy) with biopsies |
Upper endoscopy with biopsies |
Additional procedures as indicated:
|
ALT: alanine aminotransferase; ASCA: anti-Saccharomyces cerevisiae antibodies; AST: aspartate aminotransferase; C. difficile: Clostridium difficile; CBC: complete blood count; CRP: C-reactive protein; CTE: computed tomography enterography; ERCP: endoscopic retrograde cholangiopancreatography; ESR: erythrocyte sedimentation rate; GGTP: gamma-glutamyl transpeptidase; HBV: hepatitis B virus; IBD: inflammatory bowel disease; MRCP: magnetic resonance cholangiopancreatography; MRE: magnetic resonance enterography; P-ANCA: perinuclear antineutrophil cytoplasmic antibodies; UGI/SBFT: upper gastrointestinal series with small bowel follow-through.
* For a more detailed discussion of nutritional issues, refer to UpToDate topic review on growth failure in children with IBD.
Δ Before beginning treatment with immunosuppressing medications (especially infliximab and other tumor necrosis factor antibodies), patients should be tested for latent tuberculosis infection. In addition, immunization status should be carefully reviewed and brought up to date, including measurement of titers for varicella and measles, as well as HBV serologies. Live viral vaccines should not be given to patients with high-level immunosuppression.
◊ ASCA and P-ANCA have modest accuracy for distinguishing ulcerative colitis from Crohn disease. Additional testing for other antibodies such as anti-OmpC (outer membrane porin C) increases the sensitivity for IBD diagnosis and severity but does not help to categorize children with IBD-unclassified.
§ For a discussion of the selection of imaging techniques, refer to the UpToDate topic on diagnosis of IBD in children.Do you want to add Medilib to your home screen?