ORIGINAL RESEARCH article
Front. Pediatr.
Sec. Pediatric Gastroenterology, Hepatology and Nutrition
Diagnostic Efficacy of Fecal Markers Combined with Alarm Symptoms in Distinguishing Functional and Organic Abdominal Pain in Children
Provisionally accepted
- First Affiliated Hospital of Fujian Medical University, Fuzhou, China
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Objective: This study assessed the diagnostic potential of fecal markers, calprotectin (FC) and occult blood (OB), in conjunction with alarm symptoms and blood markers to differentiate functional abdominal pain (FAP) from organic disease in children. Methods: We conducted a retrospective review of children with chronic abdominal pain who presented between April 2017 and April 2020, which included 347 classified as FAP and 224 classified as organic disease. Children with constipation in the functional group were included, and a slight elevation in FC in that group was considered non-inflammatory. Interpretation of FC included age/sex norms as opposed to percentiles, utilizing the cut-off of 60 µg/g, with justification given by the ESPGHAN diagnostic criteria (JPGN 2021;72:617 640). We also analyzed a second threshold of 100 µg/g. Families were sent instructions on how to do the OB test in order to reduce the false positive rate. We utilized receiver operating characteristic (ROC) curves to quantify diagnostic performance. Results: The organic disease had significantly greater alarm symptoms and abnormal fecal and blood indices compared to FAP (P < 0.05). Alarm symptoms with fecal markers produced diagnostic accuracy compared to the six strategies we tested (AUC = 0.841, sensitivity = 90.6%, specificity = 70.3%). Both of these scores exceeded either of the markers individually. Conclusion: The combination of alarm symptoms with fecal FC and OB tests provides a sensitive and specific non-invasive strategy for the differentiation of organic from functional abdominal pain in children. The mild elevation of FC is likely indicative of functional constipation rather than inflammation, and attention should be given to diet and substances that affect OB outcome, specifically in children.
Keywords: Chronic abdominal pain, functional abdominal pain, Fecal calprotectin, Fecal occult blood test, ROC Curve
Received: 18 Sep 2025; Accepted: 24 Nov 2025.
Copyright: © 2025 Liu, Wu, Ma and Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Junhong Liu, zqljhong1985@126.com
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