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The infant with chronic vomiting: the value of the upper GI series
Natalia Simanovsky1, Carlo Buonomo, Samuel Nurko
1Department of Radiology, Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, USA.
Insights
Upper GI series rarely identify abnormalities in infants with chronic vomiting. This study suggests that radiological evaluation may not be necessary for otherwise healthy infants experiencing prolonged vomiting.
Area of Science:
- Pediatric Radiology
- Gastroenterology
Background:
- Vomiting is a common infant issue, often attributed to gastroesophageal reflux without imaging.
- Pediatric radiologists frequently perform upper GI series to rule out anatomical causes of infant vomiting.
Purpose of the Study:
- To assess the diagnostic value of upper GI series in healthy infants (1 month to 1 year) with vomiting lasting over 30 days.
- To determine the yield of upper GI series in identifying anatomical abnormalities in this pediatric population.
Main Methods:
- Retrospective analysis of clinical records and upper GI reports for 344 infants.
- Inclusion criteria: otherwise healthy infants with chronic vomiting, referred by gastroenterologists.
- Exclusion criteria: hematemesis, bilious vomiting, dysphagia, respiratory symptoms, or hospitalization.
Main Results:
- Only 2 out of 344 infants (0.6%) showed findings other than gastroesophageal reflux.
- One infant was diagnosed with duodenal stenosis.
- One infant presented with a small hiatal hernia.
Conclusions:
- The diagnostic yield of upper GI series in otherwise healthy infants with chronic vomiting is exceptionally low.
- Routine upper GI series may not be clinically justified in this specific group of infants.
- Further research could explore alternative diagnostic pathways for chronic infant vomiting.
Background:
Vomiting is very common in infants. It is usually attributed to gastroesophageal reflux and no radiological evaluation is performed. Pediatric radiologists, however, still perform many upper GI series in these infants to exclude an underlying anatomic abnormality as a cause for vomiting.
Objective:
To evaluate the yield of upper GI series in the evaluation of otherwise healthy infants 1 month to 1 year of age with vomiting for more than 30 consecutive days.
Materials And Methods:
Clinical records and upper GI reports of 344 otherwise healthy infants that were referred for UGI by pediatric gastroenterologists because of chronic vomiting were analyzed. Patients with hematemesis, bilious vomiting, dysphagia, respiratory symptoms and patients that required hospitalization were excluded.
Results:
Findings other than gastroesophageal reflux were seen in only 2 patients out of 344 (0.6%). In one patient duodenal stenosis was diagnosed. In another patient a small hiatal hernia was seen.
Conclusions:
The yield of upper GI in otherwise healthy infants 1 month to 1 year of age with chronic vomiting is extremely low, and the performance of the UGI in this specific group of patients may not be justified.