Differential Diagnosis of Inflammatory Bowel Disease and Functional Bowel Disorder in Children Based on Ultrasonography

Abstract

Objective: To study the diagnostic efficiency (DE) of sonographic signs in differentiation of inflammatory bowel disease (IBD) and functional bowel disorder (FBD) in children and to develop an optimal mathematical model for differential diagnosis of IBD and FBD using comprehensive assessment of sonographic signs.Material and methods: We examined 79 children with and without clinical signs of large-bowel disease. All the children underwent bowel ultrasonography with strain elastography. We also determined the level of fecal calprotectin (FC). The FC level > 120 μg/g was a cutoff value to differentiate IBD from FBD.Results: We determined the DE of sonographic signs in verification of IBD and FBD: large-bowel wall thickening (DE, 87%; P < .0001), large-bowel wall stratification (DE, 93.1%; P < .0001), enlarged mesenteric lymph nodes (DE, 53.4%; P=.591), interloop ascites (DE, 98.3%; P < .0001), Color Doppler findings in the large-bowel wall (DE, 98.3%; P < .0001), strain elastography findings in the large-bowel wall (DE, 96.5%; P < .0001). We developed an optimal model for differentiation of FBD and IBD using the analysis of sonographic signs (DE, 98.7%).Conclusions: The sonographic signs (large-bowel wall thickening, large-bowel wall stratification, interloop ascites, color Doppler findings in the large-bowel wall, stiffness found on strain elastography) can be effectively used for differential diagnosis of FBD and IBD in children. The developed mathematical model enables to reliably differentiate children with FBD and IBD.

Keywords

• bowel ultrasonography
• inflammatory bowel disease
• functional bowel disorder
• children
• strain elastography
• fecal calprotectin