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Gastroduodenal endoscopic-histologic correlation in pediatric patients
D D Black1, R C Haggitt, P F Whitington
1Department of Pediatrics, University of Tennessee Center for the Health Sciences, Memphis.
Insights
Upper gastrointestinal endoscopy in children often overestimates inflammation compared to biopsy results. Relying solely on visual endoscopic findings without biopsies can lead to inaccurate diagnoses of gastroduodenal inflammation.
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Endoscopy
- Histopathology
Background:
- Upper gastrointestinal endoscopy is a common diagnostic tool for children with gastrointestinal complaints.
- Visual endoscopic findings are often used to assess the severity of gastroduodenal inflammation.
- Histopathologic examination of biopsies provides a definitive diagnosis.
Purpose of the Study:
- To correlate visual findings from upper gastrointestinal endoscopy with histopathologic abnormalities in pediatric patients.
- To evaluate the accuracy of endoscopic grading of inflammation against biopsy-proven histology.
- To determine if endoscopy alone is sufficient for diagnosing gastroduodenal inflammation in children.
Main Methods:
- A study involving 94 children (mean age 8.4 years) with various gastrointestinal complaints.
- Endoscopic evaluation of the stomach and duodenal bulb, with grading of visual findings.
- Histopathologic grading of endoscopic biopsies by blinded observers.
- Comparison of endoscopic and histologic grades across gastric body, antrum, and duodenal bulb.
Main Results:
- Endoscopic grading was consistently higher than histologic grading across all studied locations.
- Mild endoscopic findings like erythema and granularity had poor predictive value for histologic inflammation.
- Severe endoscopic findings (ulcers) and significant histologic disease were infrequent in this cohort.
Conclusions:
- Endoscopic visual findings alone are unreliable for diagnosing gastroduodenal inflammation in pediatric patients.
- Histopathologic analysis of biopsies is essential for accurate diagnosis and grading of inflammation.
- Endoscopy without biopsy should not be the sole method for diagnosing pediatric gastroduodenal inflammation.
Abstract:
The histopathologic abnormalities in endoscopic biopsies from the stomach and duodenal bulb were correlated with the visual findings of upper gastrointestinal endoscopy in 94 children (mean age, 8.4 years; 51 boys and 43 girls) with a variety of complaints. Histology was graded by observers blinded to the endoscopic findings, and both endoscopy and histology were graded using scales reflecting increasing severity with increasing grade. In all three locations studied (gastric body, antrum, and duodenal bulb), endoscopic grade was significantly higher than the histologic grade. Correlation was especially poor with mild endoscopic findings such as erythema and granularity/nodularity, which had little predictive value for histologic inflammation. Few patients had severe disease with eight of 94 having ulcer by endoscopy and seven of 94 having greater than grade 2 histologic disease in any location. We conclude that endoscopy without biopsy should not be used to diagnose gastroduodenal inflammation in pediatric patients.