Evaluation of gastrointestinal pathology and treatment in children with suspected biliary dyskinesia

Area of Science:

• Pediatric Gastroenterology
• Biliary System Disorders
• Gastrointestinal Pathology

Background:

• Decreased gallbladder ejection fraction (GBEF) is linked to abdominal pain and GI diseases in children.
• Acalculous biliary-type abdominal pain in pediatric patients requires thorough gastrointestinal (GI) evaluation.
• Understanding the underlying GI pathology is crucial for effective pain management.

Purpose of the Study:

• To investigate GI tract pathology in children presenting with acalculous biliary-type abdominal pain.
• To assess the efficacy of a 2-week proton pump inhibitor (PPI) trial in alleviating pain.
• To evaluate the outcomes of laparoscopic cholecystectomy (LC) for persistent symptoms.

Main Methods:

• Pediatric patients (<18 years) with Rome III-defined biliary-type abdominal pain were enrolled.
• Upper endoscopy and proximal GI tract histologic analysis were performed.
• Patient responses to a 2-week PPI trial and subsequent LC were analyzed.

Main Results:

• Sixteen children with biliary-type pain and GBEF <35% were identified.
• Acid-related GI pathologies, including reflux esophagitis (11/16) and gastritis (3/16), were prevalent.
• Four of ten children achieved complete pain relief with PPIs, avoiding LC; nine underwent LC with four complete and four partial pain improvements.

Conclusions:

• Proton pump inhibitor (PPI) therapy shows promise as a cost-effective initial treatment for pediatric biliary-type abdominal pain.
• A significant proportion of children experienced complete pain resolution with PPIs, negating the need for laparoscopic cholecystectomy (LC).
• Laparoscopic cholecystectomy (LC) provided significant pain improvement in most cases where it was performed.