Lab evaluation chronic abdominal pain

Initial laboratory evaluation for children with chronic abdominal pain and alarm findings*

Laboratory test	Laboratory finding	Potential significance
Stool for occult blood	Positive	Enteric infection, IBD, juvenile polyps, acid-peptic disease, foreign body, vasculitis (eg, polyarteritis nodosa); proximal small bowel disease (Crohn disease, Helicobacter pylori, peptic disease, celiac disease)
Complete blood count with differential	Anemia	Celiac disease, IBD
	Leukocytosis	Infection or inflammation
	Eosinophilia	Atopic disease, eosinophilic esophagitis; parasitic infection
	Thrombocytosis	Iron deficiency, ongoing inflammation
ESR/CRP	Elevated ESR or CRP	Active inflammatory process (nonspecific)
Metabolic panel	Elevated ALT	Hepatic inflammation (eg, chronic hepatitis)
	Elevated direct bilirubin	Cholestasis
	Elevated GGT	Common bile duct stone
	Decreased albumin	Defective liver protein synthesis, intestinal protein loss (Crohn disease)
Lipase	Elevated	Acute pancreatitis
Antitissue transglutaminase	Positive	Celiac disease
Urinalysis	Hematuria	Nephrolithiasis

IBD: inflammatory bowel disease; ESR: erythrocyte sedimentation rate; CRP: C-reactive protein; ALT: alanine aminotransferase; GGT: gamma-glutamyl transpeptidase.
* Additional laboratory evaluation may be warranted if specific organic conditions are suspected.

Adapted from: Noe JD, Li BU. Navigating recurrent abdominal pain through clinical clues, red flags, and initial testing. Pediatr Ann 2009; 38:259.

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