Indications to upper gastrointestinal endoscopy in children with dyspepsia.
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.
Guariso
G
G
Gastroenterology and Endoscopy Unit, Department of Pediatrics, University of Padua, Padua, Italy. guariso@pediatria.unipd.it
Meneghel
A
A
Dalla Pozza
L Visonà
LV
Romano
C
C
Dall'Oglio
L
L
Lombardi
G
G
Conte
S
S
Calacoci
M
M
Campanozzi
A
A
Nichetti
C
C
Piovan
S
S
Zancan
L
L
Facchin
P
P
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*