title: Changing indications for upper endoscopy in children during a 20-year period.
abstract: OBJECTIVE
  In parallel with the increase in pediatric esophagogastroduodenoscopy (EGD) procedures since the 1970s, the incidence of disorders that require EGD for diagnosis in children has increased. The aim of this study was to identify changes in subject characteristics and endoscopic procedures during a 20-year interval in children undergoing EGD at a single center.
  
  
  METHODS
  All of the children undergoing first EGD with biopsy in 1985, 1995, or 2005 were identified. Details of the clinical presentation and EGD were abstracted from medical records in a random sample of subjects within each time point.
  
  
  RESULTS
  The number of first-time EGDs rose dramatically from 107 in 1985 to 1294 in 2005. The proportion of subjects that were younger than 1 year of age varied significantly from 13% in 1985 to 23% in 1995 and 8% in 2005 (P < 0.001). The proportion of subjects with gastrointestinal (GI) bleeding declined from 34% to 5% during the 20-year interval (P < 0.001), whereas the proportion with abdominal pain increased from 23% to 43% (P < 0.01). During the same interval, the proportion of subjects with complete EGD (biopsies from the esophagus, stomach, and duodenum) increased from 18% of EGDs in 1985 to 95% in 2005 (P < 0.001).
  
  
  CONCLUSIONS
  This study of children undergoing first-time EGDs with biopsy during a 20-year interval demonstrated significant differences in subject characteristics and endoscopy practices. The inclusion of children with less severe clinical presentation and the collection of greater numbers of biopsies per procedure may contribute to the rising incidence rates of pediatric GI disorders.
authors.affiliation: Cincinnati Children's Hospital Medical Center, Division of Gastroenterology, Hepatology and Nutrition, Cincinnati, OH 45229, USA. jpfranciosi@yahoo.com
authors.forename: James P
authors.initials: JP
authors.lastname: Franciosi
authors.forename: Kristin
authors.initials: K
authors.lastname: Fiorino
authors.forename: Eduardo
authors.initials: E
authors.lastname: Ruchelli
authors.forename: Justine
authors.initials: J
authors.lastname: Shults
authors.forename: Jonathan
authors.initials: J
authors.lastname: Spergel
authors.forename: Chris A
authors.initials: CA
authors.lastname: Liacouras
authors.forename: Mary
authors.initials: M
authors.lastname: Leonard
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis / Q000453:epidemiology; D017677:Age Distribution; D001706:Biopsy / Q000706:statistics & numerical data; D002648:Child; D016145:Endoscopy, Digestive System / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D005767:Gastrointestinal Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D008297:Male; D015143:Philadelphia / Q000453:epidemiology; D012189:Retrospective Studies; D012720:Severity of Illness Index