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Impact of endoscopy on management of chronic abdominal pain in children
Kalpesh Thakkar1, Faith Dorsey, Mark A Gilger
1The Section of Pediatric Gastroenterology, Hepatology and Nutrition at Baylor College of Medicine, Houston, TX 77030, USA. kthakkar@bcm.tmc.edu
Insights
Endoscopy significantly alters medical management in children with chronic abdominal pain (CAP), with two-thirds of cases seeing changes post-procedure based on findings.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Endoscopy
- Clinical Management
Background:
- Chronic abdominal pain (CAP) is common in children.
- Endoscopy is frequently used for CAP evaluation.
- The impact of endoscopy on pediatric CAP management is not well-defined.
Purpose of the Study:
- To determine the frequency of immediate medical management changes following endoscopy with biopsy in pediatric CAP patients.
- To identify factors influencing these management changes.
Main Methods:
- Prospective cross-sectional study design.
- 92 children with CAP underwent endoscopy (EGDs and EGD/colonoscopies).
- Physician management plans were compared pre- and post-endoscopy, including histopathology review.
Main Results:
- Gastroenterologists altered management in 66.3% of cases (61/92).
- Changes were driven by endoscopic or histologic findings in 75% of altered cases.
- Common changes included reassurance, dietary modifications, and medication trials (PPIs, antispasmodics).
Conclusions:
- Endoscopic evaluation leads to significant management changes in approximately two-thirds of children with CAP.
- Histologic findings did not correlate with the likelihood of management alteration.
Background:
Endoscopy is performed frequently in children with chronic abdominal pain (CAP), but its impact on clinical management is unclear.
Aims:
We aimed to examine the frequency of changes in immediate medical management resulting from endoscopy with biopsy evaluating CAP in children.
Methods:
We conducted a prospective cross-sectional study to assess the frequency and determinants of management change in children who underwent endoscopy for evaluation of chronic abdominal pain. Patients were screened prior to undergoing endoscopy according to inclusion criteria. Each endoscopist was contacted prior to performing endoscopy and recorded a management plan if endoscopy could not be performed. These responses were compared with management recommendations by the same physician after the endoscopy and review of histopathology.
Results:
We analyzed 92 endoscopic procedures [63 esophagogastroduodenoscopies (EGDs) and 29 EGD/colonoscopy] performed in 92 children (mean age 11.6 years) with CAP. Overall, gastroenterologists changed management plans post endoscopy in 61 (66.3%) patients. In 46 (75%) of these cases, management was changed as a direct result of endoscopic or histologic findings. Overall, management changes included: reassurance in 17 cases, dietary changes in 6 cases, proton pump inhibitor (PPI) trial in 11 cases, antispasmodic/anticholinergic medication trials in 4 cases, and food allergy testing in 4 cases. No significant association was found between management changes and type of histologic findings or presence of alarm symptoms.
Conclusions:
The overall rate of management change after endoscopic evaluation in children with CAP was approximately 66% (61/92). Management outcome was not associated with type of histologic findings.
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