Differential diagnosis algorithm for infantile inflammatory bowel disease
DOI:
https://doi.org/10.15574/PP.2025.3(103).115122Keywords:
children, early age, inflammatory bowel diseases, diagnostics, immunodeficiency, allergic diseases, gastrointestinal tractAbstract
Diagnosis of infantile inflammatory bowel disease (IBD) with onset in the first 2 years of life is extremely difficult and requires not only identification of typical signs of ulcerative colitis and Crohn's disease, but also recognition of atypical phenotypes, differentiation from allergic diseases of the gastrointestinal tract and IBD-like monogenic diseases.
Aim - to develop an algorithm for differential diagnosis of infantile IBD.
Materials and methods. The study involved 47 children aged from birth to 2 years. The selection of children was based on the phenotype of the infantile form of IBD. The examined children were divided into 3 groups: 1st - 20 children with the infantile form of IBD; 2nd - 6 children with primary immunodeficiency associated with an IBD-like phenotype; 3rd - 21 children with protein-induced enterocolitis. The control group consisted of 12 practically healthy children of a similar age. Clinical examination included analysis of individual and family history, patient complaints, gastroenterological and extraintestinal symptoms of the disease, assessment of physical and somatic status, nature and frequency of bowel movements, data from clinical and biochemical blood tests, and investigation of pathogens of intestinal infections. The level of interleukin-17A (IL-17A) in the blood, the level of fecal calprotectin, and the patient's immunological status were also determined. Ultrasound examination (US) of the abdominal cavity and intestines, endoscopic and morphological examination of the gastrointestinal tract were performed. The study was performed in accordance with the principles of the Declaration of Helsinki.
Results. An algorithm for differential diagnosis of infantile IBD has been developed to facilitate the diagnostic search. For children of the first two years of life with suspected IBD, it is important to analyze the history and clinical predictors of the disease, laboratory and instrumental examination with the involvement of clinical, biochemical blood tests, US of the abdominal cavity and intestines, determination of the blood IL-17A level and fecal calprotectin level, assessment of the patient's immunological status, and, if necessary, endoscopic and morphological examination of the gastrointestinal tract.
Conclusions. The developed algorithm can be applied in healthcare institutions to improve diagnostic measures and timely prescription of appropriate therapy in patients with infantile IBD.
The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the institution mentioned in the paper. The informed consent of the patient was obtained for conducting the studies.
The authors declare that there is no conflict of interest.
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