Els van de Vijver

52 Stool markers are of great help to distinguish IBD from IBS in children with only minor red flag symptoms. When children present with major red flag symptoms of IBD they will be referred for endoscopy regardless of the stool marker result. There is no added value of stool testing for triaging purposes in this category, although the knowledge of a baseline calprotectin concentration is useful for monitoring the response to treatment. Physicians should take note that different patient populations and different test assays may lead to variations in thresholds.(20,21,24) CONCLUSIONS Measuring calprotectin or calgranulin-C concentrations in stool is a useful triage tool for identifying patients who are most likely to need endoscopy for suspected inflammatory bowel disease. The discriminative power to safely exclude the disease (specificity) is significantly better than previously reported. When the optimal ROC-based thresholds are used (calprotectin 400 µg/g; calgranulin-C 0.75 µg/g), both tests perform equally well in secondary and tertiary level hospitals. ACKNOWLEDGEMENTS We would like to thank all patients and care professionals who contributed to this study, in particular J. Homan-van der Veen (Deventer Hospital), O. Norbruis (Isala Clinic), S. van Dorth (Tjongerschans), T. de Vries (Medical Center Leeuwarden), B. Delsing (Treant Zorggroep Hoogeveen), L. van Overbeek (Treant Zorggroep Emmen), A. Kamps (Martini Hospital Groningen), M. Wilsterman (Nij Smellinghe Drachten), G. Meppelink (Treant Zorggroep Stadskanaal), H. Knockaert (Admiraal de Ruyter hospital Goes), M. Claeys (St. Vincentiushospital Antwerp), and the technicians of the departments of laboratory medicine and microbiology at the University Medical Center Groningen. Chapter 3