Common Indications and The Diagnostic Yield of Esophagogastroduodenoscopy in Children with Gastrointestinal Distress

Abstract

Background The number of inconspicuous results of esophagogastroduodenoscopies (EGDs) in childhood appears to be disturbingly high. The aim of this study was to analyze the diagnostic yield of EGD and to determine its relevance of specific clinical indications.

Methods We performed a retrospective analysis of 380 consecutive pediatric patients who underwent diagnostic EGD in two German level I pediatric gastroenterology departments in 2015 and 2016.

Results 44% of the 380 patients were male and 17% were younger than 5 years old. 55% of all EGDs (n=210) did not yield a pathological result. 27% (n=104) of all EGDs were performed due to nonspecific symptoms (epigastralgia, nausea). Strikingly, in this group, 88% (n=91) showed normal results and in only 12% a diagnosis was made: reflux esophagitis (n=5), Helicobacter pylori (HP) gastritis (n=6) or hemorrhagic gastritis (n=1). Fewer inconspicuous EGDs were performed in patients with dysphagia (68%) or heartburn and reflux (61%). 59 patients were examined due to serologically elevated celiac antibodies. Here, the diagnosis could be confirmed histopathologically in 78% (n=46). Of the 37 patients with abdominal pain and a previously positive non-invasive HP test, EGD served to establish the diagnosis of HP gastritis in 84%.

Conclusions The diagnostic yield for EGDs is increased in patients with more specific symptoms (i. e. dysphagia, heartburn, HP, celiac disease). Consequently, as an invasive procedure, EGD warrants a strict indication.

Zusammenfassung

Hintergrund Die Zahl der unauffälligen Befunde der Ösophago-Gastro-Duodenoskopien (ÖGDs) im Kindes- und Jugendalter scheint beunruhigenderweise hoch zu sein. Das Ziel der folgenden Studie war es, den diagnostischen Stellenwert von ÖGDs bei Kindern zu analysieren und die Relevanz von spezifischen, klinischen Indikationen für auffällige ÖGD-Befunde zu ermitteln.

Methoden Wir führten eine retrospektive Studie von insgesamt 380 durchgeführten ÖGDs bei pädiatrischen Patienten in 2 großen pädiatrischen gastroenterologischen Abteilungen in den Jahren 2015 und 2016 durch.

Ergebnisse 44% der 380 Patienten waren männlich und 17% der Patienten waren jünger als 4 Jahre alt. 55% aller durchgeführten ÖGDs (n=210) ergaben keine pathologischen Befunde. 27% (n=104) aller ÖGDs wurden aufgrund von nicht-spezifischen Symptomen wie Oberbauchschmerzen oder Übelkeit durchgeführt. Interessanterweise hatten in dieser Gruppe 88% (n=91) der Patienten einen unauffälligen Befund und in nur 12% konnte eine eindeutige Diagnose gestellt werden: Refluxösophagitis (n=5), Helicobacter pylori (HP) Gastritis (n=6) oder hämorrhagische Gastritis (n=1). Weniger unauffällige ÖGD-Befunde waren v. a. bei Patienten mit Dysphagie (68%) oder Sodbrennen und Reflux (61%) vorkommend. 59 Patienten wurden einer ÖGD aufgrund serologisch erhöhter Zöliakie-Autoantikörper unterzogen. Hier konnte die Diagnose histopathologisch in 78% (n=46) bestätigt werden. Von den 37 Patienten mit Bauchschmerzen und einem positiven nicht-invasiven HP-Test, konnte mittels ÖGD die Diagnose einer HP-Gastritis in 84% der Fälle nachgewiesen werden.

Schlussfolgerung Der diagnostische Nutzen von ÖGDs ist v. a. bei Patienten mit spezifischen Symptomen hoch (Dysphagie, Sodbrennen, HP, Zöliakie). Die Indikation zur ÖGD als invasives diagnostisches Instrumentarium sollte v. a. bei Kindern streng gestellt werden

Key words

esophagogastroduodenoscopy - indication - Helicobacter pylori - dysphagia - reflux - abdominal pain

Schlüsselwörter

Ösophago-Gastro-Duodenoskopie - Indikationsstellung - Helicobacter pylori - Dysphagie - Reflux - Bauchschmerzen

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