FAILURE TO THRIVE: THE ENDOSCOPIC VIEW

Abstract

This is a 5 year retrospective study of endoscopic findings in 16 children with failure to thrive referred to rule out malabsorption. The inclusion criteria were flattening of the growth curve with crossing of at least 2 major percentiles and evaluation by the same endoscopist. There were 5 females and 11 males, ages 9 months to 4.5 years. Weight for height was < 5th percentile for 7 cases [43.7%], 5-10th percentile in 5 cases [31.2%] and 10th-25th percentile in 4 cases [25%]. Gestational age was > 36 weeks for all cases except 2 twins born at 30 weeks. All except one were AGA. There were no reported symptoms of acid peptic disease and no other underlying medical condition. Laboratory work up included CBC and biochemical profiles in all cases; D-xylose test [14 cases], gluten enteropathy antibody profile [15 cases], sweat tests [12 patients, all normal] and quantitative immunoglobulins [8 cases]. At endoscopy, 14 cases [87.5%] had abnormal findings which included mucosal erythema, friability, nodularity, exudate or other mucosal irregularities at one or more levels [esophagus, stomach, duodenum]. 13 cases [81.2%] had histological abnormalities: of these, 6 cases [46%] had more than one level affected. Among all cases, the histological findings included: 6 cases [37.5%] of reflux esophagitis; 2 cases [12.5%] with antral gastritis: one of which had H. pylori bacilli identified. 5 cases [31.2%] had chronic gastritis, 4 cases [25%] had chronic non-specific duodenitis and 3 cases [18.7%] had intestinal villous atrophy. There was correlation of endoscopic and histological findings in 11 cases [68.7%]. The majority of patients in this series were found to have subclinical acid-peptic disease. A small percentage had celiac disease and one case had H. pylori infection. Conclusions: Endoscopic abnormalities are frequent in children with growth deceleration initially suspected of having malabsorption. Upper endoscopy with biopsies at all levels should be considered as part of the initial work up.