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Duodenitis in children: correlation of radiologic findings with endoscopic and pathologic findings
F R Long1, S S Kramer, R I Markowitz
1Department of Radiology, Columbus Children's Hospital, OH 43205-2696, USA.
Insights
Barium studies accurately diagnose severe duodenitis in children, with mucosal-fold thickening being a key indicator. Upper GI examinations show similar accuracy to endoscopy for detecting duodenal inflammation.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Imaging
- Gastrointestinal Diseases
Background:
- Duodenitis diagnosis in children can be challenging.
- Accurate diagnostic tools are crucial for timely intervention.
- Barium studies offer a non-invasive imaging option.
Purpose of the Study:
- To evaluate the diagnostic accuracy of barium studies for duodenitis in pediatric patients.
- To compare the efficacy of upper gastrointestinal (GI) examinations with endoscopy.
Main Methods:
- Seventy-five children underwent upper GI examinations; 24 had biopsy-proven duodenitis, 51 were controls.
- Radiologic findings were assessed by blinded observers and correlated with endoscopic/histologic data.
- Duodenal mucosal-fold thickness was measured on radiographs.
Main Results:
- Barium studies showed 46% sensitivity and 98% specificity for combined mild/severe duodenitis.
- Endoscopy had 54% sensitivity and 92% specificity.
- Mucosal-fold thickening (≥4 mm) was a specific sign, particularly in severe cases.
Conclusions:
- Mucosal-fold thickening on upper GI examinations is a specific indicator of pediatric duodenitis.
- Barium studies provide diagnostic accuracy comparable to endoscopy for duodenitis.
- Further investigation of mucosal-fold thickening is warranted.
Purpose:
To determine the accuracy of barium studies in the diagnosis of duodenitis in children.
Materials And Methods:
Seventy-five children (45 boys and 30 girls; mean age, 9 years) underwent upper gastrointestinal (GI) examinations. Twenty-four of the children had biopsy-proved duodenitis, and 51 were healthy control subjects. Radiologic findings were reviewed by two experienced, blinded observers and correlated with endoscopic and histologic results. Duodenal mucosal-fold thickness was measured on spot radiographs (20% magnification), and the extent of disease was evaluated.
Results:
Of 15 children with mild duodenitis, 13 had normal radiologic findings and 11 had normal findings at esophagogastroduodenoscopy. Of nine children with severe duodenitis, all had friability or ulceration at endoscopy and mucosal-fold thickening of greater than or equal to 4 mm (> or = 3 mm in one infant aged less than 1 year) at upper GI examination. Mucosal-fold thickening was diffuse in patients with celiac, autoimmune, and adenovirus disease and was proximal in patients with peptic ulcer and Crohn disease. Of 51 control subjects, 50 had normal radiologic results, while 47 had normal endoscopic results. The sensitivity of upper GI examination for mild and severe duodenitis combined was 46% with a specificity of 98%, whereas endoscopy had a sensitivity of 54% and specificity of 92%.
Conclusion:
Mucosal-fold thickening was a specific sign of duodenitis in children and should be investigated. Upper GI examination yielded results similar to those at endoscopy.