Els van de Vijver

120 For this part of the thesis we conclude that the inclusion of the FC test in the triage for endoscopy allows to accurately select individuals with a high risk for IBD from a cohort of children with non-specific chronic intestinal complaints. Even in settings with high pre- test probability for IBD (i.e. prevalence > 70%), the optimal decision strategy based on symptoms, blood markers and faecal calprotectin continues to be beneficial. Paediatricians working at either secondary or tertiary care level can be reassured that this is a highly accurate and non-invasive approach to determine the likelihood of IBD. PART II - Quality of life beyond clinical remission: fatigue in paediatric IBD Children with IBD often experience fatigue and consider it one of the most burdensome symptoms. Fatigue is common at times of active inflammation, but a considerable proportion of the children also experiences fatigue when their IBD is in remission. The rates of fatigue in paediatric IBD are comparable to rates observed in paediatric oncology patients (50-75%).(14) IBD-related fatigue negatively impacts the quality-of-life and daily activities, including school attendance and sports participation. Despite its frequent occurrence, fatigue has only been addressed in paediatric IBD literature only scarcely and not in considerable detail. In Chapter 5 we systematically reviewed existing literature to identify factors contributing to fatigue. In the absence of randomised controlled trials, we selected cross-sectional or case-control studies reporting on fatigue in paediatric patients with IBD. The selected studies varied in the methodology to quantify or measure fatigue. Several studies used self-reporting surveys or a combination of parent-proxy reports and self-reports; only one tried to measure decline in activity with a portable pedometer. While working on the literature review it became clear that fatigue should be regarded as a multidimensional phenomenon, characterised by biological, psychobehavioral and functional factors ( table 1 ). Chapter 7 120