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Upper gastrointestinal endoscopy in recurrent abdominal pain of childhood
Insights
Recurrent abdominal pain in children often indicates underlying organic issues, with Helicobacter pylori infection and gastritis being common findings. This study highlights the need for thorough investigation beyond initial diagnoses.
Area of Science:
- Pediatric Gastroenterology
- Microbiology
Background:
- Recurrent abdominal pain (RAP) is a common pediatric complaint.
- Previous assumptions suggested functional causes were more prevalent than organic pathology.
Purpose of the Study:
- To investigate the prevalence of organic pathology in children diagnosed with recurrent abdominal pain syndrome.
- To assess the role of Helicobacter pylori infection in pediatric RAP.
Main Methods:
- Upper gastrointestinal endoscopy (gastroscopy) was performed on 82 children with RAP over 2.5 years.
- Histology, culture, and serological tests (IgG antibodies) were used to detect Helicobacter pylori infection.
- Diagnoses included gastritis, duodenal ulcer disease, esophagitis, and gastroesophageal reflux.
Main Results:
- Pathology was confirmed in 58.5% of children via gastroscopy.
- Helicobacter pylori infection was present in 37.5% of children with gastritis and 22% of all RAP cases.
- Duodenal ulcers were found in 3 H. pylori-positive children; esophagitis was linked to gastroesophageal reflux in 8 children with gastritis.
Conclusions:
- Organic pathology is more frequent in children with recurrent abdominal pain than previously recognized.
- Helicobacter pylori infection is a significant factor in pediatric RAP, associated with gastritis and duodenal ulcers.
- Endoscopic evaluation is crucial for identifying underlying organic causes in children presenting with persistent abdominal pain.
Abstract:
Over a 2.5-year period, 82 consecutive children complaining of recurrent abdominal pain underwent upper gastrointestinal endoscopy. Gastroscopy confirmed pathology in 48 of the children (58.5%). Four of the children, who also had undergone gastroscopy, had other diagnoses (lactose malabsorption, hydronephrosis, yersiniosis), and 30 of the children (36.6%) retained the initial diagnosis of recurrent abdominal pain syndrome. Gastritis was found in 48 of the children, 18 of whom (37.5%) had positive test results for Helicobacter pylori, based on histology and/or culture. Of 16 H. pylori-positive children tested, 12 (75%) also had an elevated concentration of IgG-class antibodies to H. pylori in their sera. Three of the children had duodenal ulcer disease, all of whom were H. pylori positive. Esophagitis was found in eight of the children with gastritis, all of whom were found to have gastroesophageal reflux. Our data suggest that among the children with recurrent abdominal pain syndrome, organic pathology is more common than was previously thought. Altogether 22% of the children with recurrent abdominal pain syndrome were infected with H. pylori.