title: Decreased relative diagnostic yield of esophagogastroduodenoscopy in children with gastroparesis.
abstract: BACKGROUND
  Esophagogastroduodenoscopy (EGD) and gastric emptying scintigraphy (GES) are commonly performed in the evaluation of children with upper gastrointestinal symptoms. It has been presumed, but not clarified, that gastroparesis increases the likelihood of identifying abnormalities on EGD. We sought to determine whether the presence of gastroparesis influenced the diagnostic yield of EGD in children.
  
  
  METHODS
  We conducted a retrospective chart review of children who underwent both an EGD and GES within 3 months of each other for evaluation of upper gastrointestinal symptoms (eg, abdominal pain). Clinical history (symptoms, comorbidities, medications, and surgical procedures), GES results, and EGD histology reports were captured.
  
  
  RESULTS
  A total of 125 children (46% female) were included, of whom, 70 (56%) had gastroparesis. Thirty-three (26%) children had liquid meal GES (1.2 ± 1.1 y of age, mean ± SD) and 92 (64%) had solid meal GES (12.4 ± 3.6 y of age). There was an overall trend toward a decreased frequency of biopsy abnormalities in those with gastroparesis (P=0.09). Those with gastroparesis identified through liquid meal GES were less likely to have reflux esophagitis on biopsy (P=0.002). Those with gastroparesis identified on solid meal GES were less likely to have gastritis (P=0.04). Symptoms, comorbidities, or medications were not predictive of GES or EGD results.
  
  
  CONCLUSIONS
  Children with gastroparesis may be less likely to have biopsy abnormalities identified on EGD in comparison to those without gastroparesis. Further prospective, larger, and multicenter studies are needed to validate our findings.
authors.affiliation: *Department of Pediatrics, Baylor College of Medicine †Texas Children's Hospital ‡ARS/USDA Children's Nutrition Research Center, Houston, TX.
authors.forename: Gregory K
authors.initials: GK
authors.lastname: Wong
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Shulman
authors.forename: Eric H
authors.initials: EH
authors.lastname: Chiou
authors.forename: Bruno P
authors.initials: BP
authors.lastname: Chumpitazi
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D016099:Endoscopy, Gastrointestinal; D004942:Esophagitis, Peptic / Q000150:complications / Q000473:pathology* / Q000503:physiopathology; D004947:Esophagus / Q000473:pathology* / Q000503:physiopathology; D005260:Female; D005746:Gastric Emptying; D005756:Gastritis / Q000150:complications / Q000473:pathology* / Q000503:physiopathology; D018589:Gastroparesis / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D013270:Stomach / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology