Inflammatory bowel disease: Viva

Branch 1: Diagnosis and the Porto criteria

The candidate should recognise that the combination of chronic diarrhoea, weight loss, growth faltering, a raised faecal calprotectin, and a family history of Crohn disease makes inflammatory bowel disease the leading diagnosis and warrants endoscopic confirmation rather than further observational delay. The key is to name the ESPGHAN revised Porto criteria and describe the diagnostic strategy precisely. ^[1]

Ileocolonoscopy with biopsies from every segment including the terminal ileum is the minimum diagnostic procedure, and the candidate should emphasise that upper gastrointestinal endoscopy is also recommended at diagnosis in all suspected paediatric IBD. A strong candidate explains why: isolated upper-gut Crohn disease is common in children and is missed by colonoscopy alone. The candidate should also list the supporting tests, including full blood count, inflammatory markers, coeliac serology with total immunoglobulin A, and stool studies to exclude infection. ^[1]

If the examiner presses on the role of faecal calprotectin, the candidate should explain that it is the single best non-invasive marker of intestinal inflammation and a useful screen for organic disease, but that a raised value always requires endoscopic confirmation rather than treatment on the strength of the number alone. The candidate should also mention magnetic resonance enterography for small-bowel assessment and the PCDAI or PUCAI for quantifying disease severity. ^[1]