Impact of Endoscopy on Management of Chronic Abdominal Pain in Children

Abstract

Endoscopy is performed frequently in children with chronic abdominal pain (CAP), but its impact on clinical management is unclear. We aimed to examine the frequency of changes in immediate medical management resulting from endoscopy with biopsy evaluating CAP in children. We conducted a prospective cross-sectional study to assess the frequency and determinants of management change in children who underwent endoscopy for evaluation of chronic abdominal pain. Patients were screened prior to undergoing endoscopy according to inclusion criteria. Each endoscopist was contacted prior to performing endoscopy and recorded a management plan if endoscopy could not be performed. These responses were compared with management recommendations by the same physician after the endoscopy and review of histopathology. We analyzed 92 endoscopic procedures [63 esophagogastroduodenoscopies (EGDs) and 29 EGD/colonoscopy] performed in 92 children (mean age 11.6 years) with CAP. Overall, gastroenterologists changed management plans post endoscopy in 61 (66.3%) patients. In 46 (75%) of these cases, management was changed as a direct result of endoscopic or histologic findings. Overall, management changes included: reassurance in 17 cases, dietary changes in 6 cases, proton pump inhibitor (PPI) trial in 11 cases, antispasmodic/anticholinergic medication trials in 4 cases, and food allergy testing in 4 cases. No significant association was found between management changes and type of histologic findings or presence of alarm symptoms. The overall rate of management change after endoscopic evaluation in children with CAP was approximately 66% (61/92). Management outcome was not associated with type of histologic findings.