title: Indications to upper gastrointestinal endoscopy in children with dyspepsia.
abstract: OBJECTIVE
  The objective of the study was to ascertain the appropriateness of indications for upper gastrointestinal (UGI) endoscopy in children with dyspepsia.
  
  
  METHODS
  We used the RAND/University of California at Los Angeles method to investigate the appropriateness of the opinions of a panel of experts. The panel judged 2304 theoretical patient scenarios defined by a combination of demographic and clinical variables. Descriptive and multivariate logistic regression analyses were performed.
  
  
  RESULTS
  The panel rated UGI endoscopy as appropriate in 27.2% of cases, inappropriate in 14.3%, and dubious in 58.5%. Disagreement emerged for 21% of cases. UGI endoscopy was considered increasingly appropriate in cases with a positive family history of peptic ulcer and/or Helicobacter pylori infection (odds ratio [OR] 8.518, P < 0.0001), when dyspepsia interfered with activities of daily living ("sleep" OR 7.540, P < 0.0001; "normal activities" OR 5.725, P < 0.0001), and when patients were older than 10 years ("<or=10 years" OR 0.310, P < 0.0001) the longer the duration ("0-2 months" OR 0.002, P < 0.0001; "3-5 months" OR 0.059, P < 0.0001; "6-11 months" OR 0.516, P = 0.0005) and the greater the severity ("mild" OR 0.002, P < 0.0001; "moderate" OR 0.013, P < 0.0001) of their dyspeptic symptoms.
  
  
  CONCLUSIONS
  UGI endoscopy is not appropriate for all children with dyspeptic symptoms, but only for cases with a family history of peptic ulcer and/or Helicobacter pylori infection, older than 10 years of age, with symptoms persisting for more than 6 months and severe enough to affect activities of daily living.
authors.affiliation: Gastroenterology and Endoscopy Unit, Department of Pediatrics, University of Padua, Padua, Italy. guariso@pediatria.unipd.it
authors.forename: G
authors.initials: G
authors.lastname: Guariso
authors.forename: A
authors.initials: A
authors.lastname: Meneghel
authors.forename: L Visonà
authors.initials: LV
authors.lastname: Dalla Pozza
authors.forename: C
authors.initials: C
authors.lastname: Romano
authors.forename: L
authors.initials: L
authors.lastname: Dall'Oglio
authors.forename: G
authors.initials: G
authors.lastname: Lombardi
authors.forename: S
authors.initials: S
authors.lastname: Conte
authors.forename: M
authors.initials: M
authors.lastname: Calacoci
authors.forename: A
authors.initials: A
authors.lastname: Campanozzi
authors.forename: C
authors.initials: C
authors.lastname: Nichetti
authors.forename: S
authors.initials: S
authors.lastname: Piovan
authors.forename: L
authors.initials: L
authors.lastname: Zancan
authors.forename: P
authors.initials: P
authors.lastname: Facchin
mesh_terms: D000203:Activities of Daily Living; D000367:Age Factors; D002648:Child; D004415:Dyspepsia / Q000209:etiology*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005190:Family; D041981:Gastrointestinal Tract; D020022:Genetic Predisposition to Disease; D016481:Helicobacter Infections / Q000175:diagnosis; D016480:Helicobacter pylori; D006801:Humans; D016015:Logistic Models; D016017:Odds Ratio; D010437:Peptic Ulcer; D012720:Severity of Illness Index; D013997:Time Factors; D041742:Upper Gastrointestinal Tract / Q000473:pathology*