Is Endoscopy Useful in the Investigation of Chronic Abdominal Pain in Children?

Background: Investigation for chronic or recurrent abdominal pain is frequently requested in paediatric surgery. The senior author had felt that endoscopy in this setting is rarely useful. Accordingly a retrospective review of our unit’s practice was performed to ask the question "how often is endoscopy useful in managing children with chronic abdominal pain?

Objective: To review the usefulness of gastroscopy in the investigation of chronic paediatric abdominal pain.

Methods: Retrospective chart review of all paediatric gastroscopies performed during the last 15 years. This paper focuses on those referred for abdominal pain. Demographic data, reason for referral, and pathological findings were reviewed and compared with children referred for other reasons.

Results: 141 patients referred for investigation of non-specific abdominal pain were reviewed, from a total of 1779 paediatric endoscopies. 75 were female, and 66 male. The average age of those referred for pain was 11.02 years. The average age of 1638 referred for all other reasons was 7.89 years. (p << 0.01)
41% of children had completely negative examinations. 30% had a gastropathy, and 29% microscopic findings of oesophagitis, contrasting with 30% of children gastroscoped for all indications who had a gastropathy. Only those being investigated for coeliac disease were more likely to have reactive gastropathy: 54%.
Specific diagnoses included eosinophilic oesophagitis(EoE): 5; Helicobacter gastritis: 3; other acute gastritis: 5; coeliac disease: 5; gastric or duodenal polyps: 2.

Conclusion: 141 scopes were performed to make few specific new diagnoses. Low grade chronic changes are commonly reported in both stomach and oesophagus regardless of presentation, and are positively correlated with coeliac disease. The diagnostic yield is not sufficiently high to recommend indiscriminate use of endoscopy in non specific abdominal pain. It is not clear that mucosal changes always explain symptoms of chronic abdominal pain in children.