Does EGD Identify Causes of Abdominal Pain in Children?

Esophagogastroduodenoscopy (EGD) is a useful tool for the diagnosis of children with abdominal pain, researchers report in the June issue of Clinical Gastroenterology and Hepatology.

The procedure identified disorders for which medical therapy was effective in 67% of children. Chronic abdominal pain is the most common indication for EGD in children. However, little is known about the accuracy of EGD-based diagnosis or the outcomes of the patients who undergo this procedure. In a prospective study, Kalpesh Thakkar et al.  examined the diagnostic yield of EGD and short-term outcomes of 290 children who underwent this procedure for chronic abdominal pain.

They found that, overall, EGD provided an accurate diagnosis for 109 children (38%). Diagnoses included esophagitis (21.0%), eosinophilic gastroenteritis (4.1%), eosinophilic esophagitis (3.8%), Helicobacter pylori infection (2.0%), celiac disease (0.6%), and Crohn’s disease (0.4%). Short-term outcomes were available for 81% of patients with diagnostic findings, and medical therapy was effective in approximately 67% of these children.

The authors noted that esophagitis was the most common abnormal finding (26%) in children with chronic abdominal pain. Several studies in children confirm that abdominal pain is a frequent presenting symptom of gastroesophageal reflux disease (GERD). Most of the patients in the study of Thakkar et al. (68%) attempted treatment with proton pump inhibitors before EGD, but the presence or response to this therapy did not identify children with esophagitis or GERD.

Thakkar et al. therefore do not recommend proton pump inhibitor therapy before EGD, because the treatment was not associated with a higher diagnostic yield, and most of the children studied (79%) did not have reflux esophagitis.

Further, controlled studies are therefore required to investigate the long-term outcomes of children with chronic abdominal pain who undergo endoscopy.

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