Is Bile in the Stomach Related to Paediatric Chronic Abdominal Pain?

Background/Aim: While bilious vomiting is regarded as a worrying symptom and sign in acute paediatric surgery, chronic abdominal pain is a common non-acute reason for referral for endoscopy. Chronic non-specific gastritis is often reported on biopsy in our patients. The authors asked how often bile was seen in the stomach on gastroscopy, and asked whether this correlated with gastric pathology to support the notion of bile gastritis as a cause of chronic abdominal pain in children.

Methods: Retrospective chart review of a paediatric gastroscopy practice. Routine biopsies are usually taken from gastric antrum. Gastric contents were noted. Only patients with recorded gastric contents were included. The pathology report was reviewed. Data were stored in Excel. Presence of gastric bile was compared against histology and presentation. Proportions were compared by Fisher exact test.

Results: 769 patients with available data on the gastric contents were reviewed, 743 of whom had histopathology reports. Results are summarised in the table. These proportions were not significantly different by Fischer Exact test. Patients with bile stained gastric contents however were nearly twice as likely to have been referred for investigation of abdominal pain as those with no bile staining. (16% vs 9% p=0.007 by Fisher exact test.) No relationship to distal oesophageal reflux changes was found to explain the pain correlation.

Conclusions: While bilious vomiting remains a red flag of the greatest importance, the presence of bile in the stomach without vomiting has no clear relation to gastric histopathology, but may be associated with abdominal pain.