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Basal gastric acid secretion in children with atypical epigastric pain
M J Collen1, C A Ciarleglio, V J Stanczak
1Department of Medicine, Georgetown University School of Medicine, Washington, D.C.
Insights
Children with atypical abdominal pain may have higher basal acid output (BAO). This study found elevated BAO in children with acid-peptic mucosal disease, suggesting a need for adjusted antisecretory medication doses.
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Physiology
Background:
- Atypical recurrent abdominal pain in children is often challenging to diagnose.
- Acid-peptic disorders are a potential cause of such symptoms.
Purpose of the Study:
- To investigate basal acid output (BAO) in children with atypical recurrent abdominal pain.
- To determine if elevated BAO correlates with acid-peptic mucosal disease.
Main Methods:
- Nasogastric aspiration was used to measure BAO in 28 children.
- Upper endoscopies and esophageal biopsies were performed.
- BAO was compared between children with and without acid-peptic mucosal disease.
Main Results:
- Children with acid-peptic mucosal disease had significantly higher mean BAO (6.8 mEq/h) than those without (2.4 mEq/h).
- Gastric volumes were also significantly greater in children with mucosal disease.
- Some children with acid-peptic disease exhibited gastric acid hypersecretion, requiring higher H2 blocker doses.
Conclusions:
- BAO values in children are comparable to adult levels.
- Measuring BAO can identify children with atypical abdominal pain who are acid hypersecretors.
- These patients may require higher antisecretory medication doses for optimal treatment.
Abstract:
We investigated basal acid output (BAO) by nasogastric aspiration in 28 children with atypical recurrent abdominal pain, defined as subxyphoid or epigastric pain of more than 3 months duration, associated with vomiting, anorexia, failure to thrive, and/or nocturnal awakening. Twenty-one children had normal upper endoscopies with no esophageal mucosal disease on biopsy, and seven had acid-peptic mucosal disease seen either on endoscopy or on esophageal biopsy. Mean BAO in the children with acid-peptic mucosal disease (6.8 +/- 4.3 mEq/h) was significantly higher than the mean BAO in the children with no mucosal disease (2.4 +/- 1.7 mEq/h) (p less than 0.02). Gastric volumes were also significantly greater in the children with acid-peptic mucosal disease than in children with no mucosal disease (p less than 0.001). There was no significant correlation between body weight and either BAO or basal volume output. Three of seven children with acid-peptic mucosal disease had a BAO greater than two standard deviations above the mean for the group with no mucosal disease. Two of these three had a BAO of more than 10.0 mEq/h (defined as gastric acid hypersecretion in adults), and required higher than usual doses of H2 blocker therapy. These results indicate that the values for BAO in children (greater than 2 yr) are comparable to values recorded in adults. Moreover, measurement of BAO may define a subgroup of children with atypical abdominal pain who are hypersecretors of acid and who require higher doses of antisecretory agents in order to achieve an optimal clinical response.