Coeliac disease | Weight velocity worse than height velocity | Anti-endomysial IgA antibodies as long as IgA concentrations normal |
Crohn’s disease | Abdominal pain and oral ulceration and deep anal fissures | CRP, ESR |
Consider radioisotope WBC scan |
Upper and lower gastrointestinal endoscopy and biopsy |
Lichen sclerosis et atrophicus | Usually girl with thickened perianal fissured skin | Dermatological opinion |
Hypothyroidism | Height velocity poor | TSH and thyroid antibodies |
Pelvic/spinal tumours | Urinary symptoms severe | Ultrasound and spinal MRI scan |
Chronic intestinal pseudo-obstruction | Upper gastrointestinal symptoms, reflux, failure to thrive | Electrogastrograms/contrast meal |