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Invited Commentaries

Importance of Physical Examination

Occult Blood and Perianal Examination in Screening for Pediatric Inflammatory Bowel Disease

McCracken, Marjorie

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Journal of Pediatric Gastroenterology and Nutrition: July 2015 - Volume 61 - Issue 1 - p 3
doi: 10.1097/MPG.0000000000000808
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See “Occult Blood and Perianal Examination: Value Added in Pediatric Inflammatory Bowel Disease Screening” by Moran et al on page 52.

In this issue of the Journal of Pediatric Gastroenterology and Nutrition, Moran et al (1) remind us of the importance of physical examination in identifying potentially ill patients. The authors demonstrate that doing a perianal inspection combined with fecal occult blood testing (clearly designed as a less invasive substitute for a rectal examination) significantly improves the identification of children with inflammatory bowel disease (IBD) compared with screening with blood tests only. In the present era of reliance on labs and imaging, we often forget that physical findings are important in screening patients and sorting the well from the potentially ill. It is particularly tempting to skip doing a rectal examination or perianal inspection because many children regard these exams as an invasion of privacy and actively resist. These examinations also may require chaperoning, which can slow down a busy clinic (2).

We should remember that examining the perianal area and doing a rectal examination are important in evaluating many gastroenterological complaints in children including abdominal pain, rectal bleeding, diarrhea, and constipation. Failing to do so risks missing anal anomalies, perianal strep infection, lichen sclerosis and atrophicus, tethered cord, pilonidal disease, and others in addition to IBD. We were all taught the importance of physical examination in medical school. This article is an excellent reminder of that fact.


1. Moran CJ, Kaplan JL, Winter HS, Masiakos PT. Occult blood and perianal examination: value added in pediatric inflammatory bowel disease screening. J Pediatr Gastroenterol Nutr 2015; 61:52–55.
2. The use of chaperones during the physical examination of the pediatric patient. American Academy of Pediatrics Committee on Practice and Ambulatory Medicine. Pediatrics 1996; 98:1202.
© 2015 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,