EGD can be diagnostic for children’s abdominal pain

MedWire News: US study findings suggest that esophagogastroduodenoscopy (EGD) may be diagnostic in more than a third of children who experience chronic abdominal pain.

Their study showed that EGD had diagnostic yield, in contrast with most alarm symptoms and routine laboratory tests evaluated.

EGD is not generally recommended for the evaluation of chronic abdominal pain, say K Thakkar (Baylor College of Medicine, Houston, Texas) and colleagues.

Noting that existing outcome studies are limited, however, they performed a cross-sectional study of individuals aged less than 18 years who underwent EGD for a primary indication of abdominal pain at two US centers between January 2002 and June 2005.

Diagnostic yield was defined on the basis of endoscopic findings in procedure notes or histological changes in biopsy reports, and defined as having potential therapeutic or prognostic value.

EGD was diagnostic in 38.1% of the 1191 procedures, the team reports in the journal Alimentary Pharmacology and Therapeutics.

Reflux esophagitis was the most common diagnosis, identified in 23%, followed by Helicobacter pylori infections in 5%, peptic ulcers in 3%, and erosive esophagitis in 2%.

Celiac disease was identified in 1%, and Crohn’s disease in 0.5%.

Specific alarm symptoms or signs studied included involuntary weight loss, deceleration of linear growth, gastrointestinal blood loss, significant vomiting, chronic severe diarrhea, or family history of inflammatory bowel disease.

However, only significant vomiting, which included daily vomiting for more than 2 weeks or bilious vomiting of any duration, was associated with increased diagnostic yield. Male gender, older age, and elevated C-reactive protein were also associated with increased diagnostic yield, the authors note.

“Our findings suggest that [EGD] is valuable for the evaluation of chronic abdominal pain in children, with a diagnostic yield of 38%,” they conclude.