title: Impact of pediatric Rome III criteria of functional dyspepsia on the diagnostic yield of upper endoscopy and predictors for a positive endoscopic finding.
abstract: OBJECTIVE
  Pediatric Rome III criteria of functional dyspepsia (FD) has eliminated the mandatory use of upper endoscopy and recommended a symptom-based approach. In the absence of alarm symptoms, FD can be positively diagnosed in children having normal physical findings without exclusionary investigations. We aimed to investigate the effectiveness of Rome III guidelines to discriminate organic diseases from FD and to identify the predictors for positive endoscopic findings.
  
  
  METHODS
  A prospective study was conducted on consecutive children fulfilling Rome III criteria of FD. Upper endoscopy was performed in all subjects, both with and without alarm features.
  
  
  RESULTS
  Eighty consecutive children ages 7 to 15 were recruited. Nine (11.3%) had experienced alarm features. Five (6.3%) had organic diseases confirmed in upper endoscopy: duodenal ulcer (n = 2), duodenitis with erosion (n = 2), and gastritis with erosion (n = 1), 33.3% of children having alarm features had organic pathology, compared with 2.8% of those without (P < 0.01). A male predominance (80% vs 25.3%, P < 0.01), higher prevalence of alarm features (60% vs 8%, P < 0.01), and higher prevalence of Helicobacter pylori infection (80% vs 5.3%, P < 0.01) were found in children with organic diseases, compared with FD. Multivariate analysis identified H pylori infection (odds ratio 23.2; 95% confidence interval 1.5-333) and nocturnal pain (odds ratio 26.3; 95% confidence interval 1.2-500) to be independent predictors for positive endoscopic findings.
  
  
  CONCLUSIONS
  Rome III recommendations of screening dyspeptic children for alarm features and investigation for H pylori are effective to identify children who have a higher likelihood of organic diseases and require upper endoscopy before making a diagnosis of FD.
authors.affiliation: Division of Paediatric Surgery & Paediatric Urology, Department of Surgery, Prince of Wales Hospital, Shatin, NT, Hong Kong, China. pyhtam@hotmail.com
authors.forename: Yuk Him
authors.initials: YH
authors.lastname: Tam
authors.forename: Kin Wai
authors.initials: KW
authors.lastname: Chan
authors.forename: Ka Fai
authors.initials: KF
authors.lastname: To
authors.forename: Sing Tak
authors.initials: ST
authors.lastname: Cheung
authors.forename: Jennifer Wai Cheung
authors.initials: JW
authors.lastname: Mou
authors.forename: Kristine Kit Yi
authors.initials: KK
authors.lastname: Pang
authors.forename: Yuen Shan
authors.initials: YS
authors.lastname: Wong
authors.forename: Jennifer Dart Yin
authors.initials: JD
authors.lastname: Sihoe
authors.forename: Kim Hung
authors.initials: KH
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D002648:Child; D002681:China / Q000453:epidemiology; D003937:Diagnosis, Differential; D003938:Diagnostic Techniques, Digestive System; D004415:Dyspepsia / Q000209:etiology*; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005767:Gastrointestinal Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D006801:Humans; D008297:Male; D010044:Outpatient Clinics, Hospital; D010372:Pediatrics / Q000379:methods; D017410:Practice Guidelines as Topic; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012955:Societies, Medical