Recurrent Abdominal Pain In Children Research Articles

Clinical case of median arcuate ligament syndrome in the practice of a pediatric surgeon

Recurrent abdominal pain in childhood and adolescence may be indicative of chronic mesenteric ischemia with median arcuate ligament syndrome as a result of compression of the celiac artery by the median arcuate ligament of the diaphragm and its internal crura, neurofibrous tissue of the celiac plexus. The presence of symptoms characteristic of various diseases of gastrointestinal tract organs, absence of pathognomonic signs and complex approach in diagnostics of abdominal cavity vascular system, insufficient awareness of specialists of children’s outpatient clinics determine the urgency of timely diagnostics and treatment of patients with this pathology. Median arcuate ligament syndrome, or Dunbar syndrome, is more often a congenital malformation. This syndrome can be considered as an acquired pathology in the case of compression of the celiac artery by enlarged lymph nodes and neurofibrous tissue of the celiac plexus. In addition to hemodynamically significant disorders of blood supply to the gastrointestinal tract, Dunbar syndrome in children and adolescents is also accompanied by psycho-emotional disorders due to the presence of unstable stools, recurrent abdominal pain, and often repeated ineffective requests for medical care. Clinical observation, methods of diagnosis and surgical treatment of median arcuate ligament syndrome in a 14-year-old patient are presented in the study.

Recurrent abdominal pain in children: a review

Recurrent tummy (abdominal) pain (RAP) is among the most prevalent symptoms where children experience frequent stomach pain over an extended period. RAP is prevalent in children, affecting 10-20% of school aged children. There is no consensus regarding this widespread issue's genesis, investigation, and management. This review touches on a few concerns about children's recurrent abdominal pain.

Helicobacter Pylori Infection among Children with Recurrent Abdominal Pain: A Single Center Study

Background: Recurrent abdominal pain (RAP) is a common problem in children. Mostly it is functional, but due to recent advanced diagnostic technologies more organic causes are identifying. Among the organic causes Helicobacter pylori (H. pylori) infection is common, especially in developing countries. Early detection and treatment of this infection may prevent some serious gastrointestinal problems in later age. Objective: To evaluate the frequency of H. pylori infection as a cause of recurrent abdominal pain in children. Methods: This cross sectional study was conducted among the children with recurrent abdominal pain (RAP) in the pediatric Gastroenterology, Hepatology & Nutrition Department of Bangladesh Shishu Hospital & Institute in Bangladesh from January 2019 to December 2020. A total of 70 patients were included in the study. Demographic data, clinical manifestations, laboratory parameters were recorded in a standard data sheet. All the participants underwent to upper GI endoscopy and gastric biopsy were taken in all the patients. Rapid urease test and histopathology of gastric biopsy samples were done to confirm H. pylori infection. Collected data were checked manually and analyzed by SPSS version 22.0. Association of parameters with infection were done by unpaired t-test, chi-square test and fisher’s exact test. Results: Helicobacter pylori infection in children with RAP was 35.7%. Mean age of the infected children was 9.49±2.47 years with male (52%) predominance. There was significant association of infection with lower socioeconomic class (p=0.003). Patients with RAP for>6 months’ duration were significantly associated with infection (p=0.003). Family size and source of drinking water had no effect on results. Most of the RAP patients with positive infection had poor growth (p=0.003). Pallor, abdominal tenderness or vomiting were not significantly associated clinical manifestations of H. pylori infection. Conclusions: Helicobacter pylori infection is ....

Pancreatic Stones in Children with Chronic Pancreatitis: A Case Report

Background: Chronic pancreatitis is a continuous progressive inflammation of the pancreas that can cause recurrent abdominal pain. The incidence of chronic pancreatitis in children is on an upward trend in recent years. The purpose of this case report is to enhance clinician's insight in considering chronic pancreatitis as a differential diagnosis in cases of recurrent abdominal pain in children. Case: We reported a case of chronic pancreatitis with pancreatic stones in a 12-year-old child. The patient came with complaints of recurrent upper left abdominal and heartburn accompanied by nausea and vomiting. Epigastric and left hypochondriac tenderness were found. Laboratory examination showed an increase in pancreatic enzymes up to 6x the normal value. The results of abdominal CT-scan and MRCP showed multiple pancreatic stones with pseudocysts. The patient then underwent the Puestow procedure. Postoperatively, the complaints of abdominal pain resolved and the pancreatic enzymes improved significantly. Discussion: The diagnosis of pancreatitis must meet 2 out of the 3 criteria that have been determined. Primary management includes fluids, analgesics, early nutrition, and surgery in cases of chronic pancreatitis accompanied by complications such as pseudocysts or pancreatic stones. Conclusion: This case teaches the need for a careful clinical approach and consideration of chronic pancreatitis as a differential diagnosis in a child with recurrent abdominal pain.

Parental Involvement in Psychological Interventions for Recurrent Abdominal Pain in Childhood

ABSTRACT There are a variety of different psychological interventions used to treat recurrent abdominal pain in childhood. Active components in these interventions are unclear. Parents play an important role when it comes to their children's response to pain and management of pain, and are regularly involved in interventions. Four electronic databases were searched (CINAHL Complete, Medline, APA PsychArticles and APA PsychInfo) in order to examine in what ways parents are involved across different therapeutic modalities, and interventions delivered in a variety of formats. In this descriptive review of the literature, 30 studies were included with a total of 1848 participants ranging from age 4–18. The review also discusses the outcomes of studies involving parents. Most of the studies in this review involved parents through psycho-education about pain and strategies for managing pain, however, it remains unclear how parental involvement impacts outcomes. Further research is needed to determine the active components in psychological interventions for recurrent abdominal pain. This research should also include how parental involvement impacts these interventions.

Correlation between fecal (calprotectin and lactoferrin) results and colonoscopic findings in chronic diarrhea and recurrent abdominal pain in children and adolescents

Background: Currently, endoscopy with biopsy is still considered the gold standard for the evaluation and diagnosis of mucosal inflammation and a number of scores exist to assess endoscopic activity in Crohn’s disease (CD) and ulcerative colitis (UC). Aim and objectives: the aim of the study was to determine the benefit of using both of fecal markers (calprotectin and lactoferrin) in patients presenting with chronic diarrhea and recurrent abdominal pain for differentiation between organic diseases, particularly inflammatory bowel disease (IBD) from non-organic disease, making colonoscope unnecessary. Subjects and methods: This prospective, observational and analytic study was carried out on 44 children who fulfilling the designed inclusion criteria. The study was carried out from Outpatient Clinic of Pediatric gastroenterology unit and from the Inpatient Units of the Pediatric department Faculty of Medicine, Al-Azhar University Hospitals (Al-Hussein & Sayed Galal Hospitals), as well as referral from other hospitals complaining of recurrent abdominal pain and chronic diarrhea from March 2020 to March 2022. Results: there was statistically significant difference between IBD group and functional abdominal pain group as regard fecal calprotectin with p-value≤ 0.001. There was statistically significant difference between IBD group and functional abdominal pain group as regard fecal lactoferrin with p-value≤ 0.001.

Importance and Role of Upper Gastrointestinal Endoscopy in Diagnosis of Recurrent Abdominal Pain in Children

Objective: The purpose of this study is to determine the effectiveness of upper gastrointestinal endoscopy in diagnosis of recurrent abdominal pain in children. Study Design:Retrospective study. Place and Duration: Department of Gastroenterology, HITEC-IMS Taxila Cantt. 1st July 2021-31st Dec 2021 Methods:There were 78 children of both genders with ages >14 years were presented in this study. After obtaining the authority's informed written permission, we took detailed demographic information, such as age, gender, weight, and symptoms, for all of the recruited patients. All the patients were underwent for upper gastrointestinal endoscopy to diagnose recurrent abdominal pain. Prevalence of dyspepsia and H.pylori infection was also recorded among children. We used SPSS 23.0 to analyze complete data. Results: Among 78 children, 42 (53.8%) were boys and 36 (46.2%) were girls. Majority of the patients 45 (57.7%) were ages between 4-8 years followed by 9-14 years 25 (32.1%) and 8 (10.3%) were in age group 1-3 years. Most common symptom was anemia, followed by vomiting, haematemesis, melena and weight loss. Frequency of dyspepsia was found in 22 (28.2%) and helicobacter pylori found in 29 (37.2%) children. Most common diagnosis of endoscopy was gastritis found in 33 (42.3%) case, gastric erosions in 14 (17.9%) cases, hiatus hernia in 8 (10.3%) cases and remaining were gastric ulcer, gastric polyp and duodenitis. Hypoxemia, apnea and aspirationwere the most common complications found in our study. Conclusion: In this study, we found that upper gastrointestinal endoscopy remains an essential tool in the evaluation of RAP in children because it allows for accurate diagnosis of GI causes of RAP, despite reported complications such as hypoxemia, apnea, aspiration and choking, cardiac arrhythmias, bacteremia, perforation, and bleeding. Keywords:Upper GI Endoscopy, Findings, Complications, Children

Role of H. Pylori infection with Recurrent Abdominal Pain in Young Age Children

Objective: A study was conducted to determine the incidence of Helicobacter pylori infection in children who had chronic abdominal pain. Study Design: Cross-sectional study. Study and Duration of Study: This research was carried out during 1.1.2019 to 1.6.2020 in the DHQ Sargodha. Materials and Methods: According to the findings, there were 200 participants in the study, and 8 percent of those with Recurrent Abdominal Pain had Helicobacter. Results: The patients ranged in age from 12.43 to 12.43 and 1.23 months on average. Between 8 and 16 years old, the average age of the sample group was observed. The average number of months that participants were bothered by stomach discomfort was 4.23. The presence of Helicobacter pylori was confirmed in 47% of those who were tested. Conclusion: Helicobacter pylori is a common cause of recurrent abdominal pain in children, and it can be treated with antibiotics. In children and adolescents, it is a serious problem, and more research is needed to determine the risk factor that is linked to an increased Helicobacter Pylori infection rate. Keywords: Recurrent Abdominal Pain, abdominal pain, Helicobacter pylori

Risk Factors for Recurrent Abdominal Pain in Children with Nonorganic Acute Abdominal Pain.

PurposeThe purpose of this study was to identify the risk factors for recurrent abdominal pain (RAP) in children who presented with nonorganic acute abdominal pain.MethodsA retrospective, single study was conducted on 2–15-year-old children diagnosed with nonorganic acute abdominal pain at the pediatric outpatient department of Vajira Hospital, Nawamindradhiraj University, between January 2015 and December 2019. The potential risk factors were analyzed using univariate and multivariate analyses.ResultsOf the 367 patients with nonorganic acute abdominal pain, 94 (25.6%) experienced RAP within three months. In this group with RAP, 76 patients (80.8%) were diagnosed with functional gastrointestinal disorders, including functional dyspepsia, irritable bowel syndrome, functional abdominal pain-not otherwise specified, and functional constipation. History of gastrointestinal infection (p=0.011), mental health problems (p=0.022), abdominal pain lasting ≥7 days (p<0.001), and change in stool frequency (p=0.001) were the independent risk factors associated with RAP in children with nonorganic acute abdominal pain; their odds ratios and 95% confidence intervals were 3.364 (1.314–8.162), 3.052 (1.172–7.949), 3.706 (1.847–7.435), and 2.649 (1.477–4.750), respectively.ConclusionRAP is a common problem among children who first present with nonorganic acute abdominal pain. The identification of risk factors may provide proper management, especially follow-up plans for this group in the future.

Parental experiences of psychological interventions for recurrent abdominal pain in childhood.

Active components of psychological intervention for RAP remain unclear. This study involved completing interviews about parental experience of psychological intervention for RAP to ascertain how and why psychological intervention can be effective. Difficulty making sense of RAP and barriers to treatment were identified as struggles. Acceptance and containment were key overlapping mechanisms, which allowed families to develop a changed relationship with the pain and manage the impact of pain. To further develop interventions, the role of containment should be considered and acceptance-based interventions explored, given the growing evidence base in this area. Practical implications of this research are also discussed.

Абдомінальний больовий синдром у дітей та підлітків: можливості терапії

Біль у животі — частий привід для звернення пацієнтів різного віку до лікаря, одна з найбільш частих скарг, що пред’являються дітьми та їх батьками. Больовий абдомінальний синдром у дітей — це сукупність симптомів, що супроводжують різні хірургічні та нехірургічні захворювання, одним із проявів яких є біль у животі. Розрізняють гострий і хронічний (рецидивуючий) біль. Гострий біль у животі може бути проявом хірургічної патології, травми або гострого інфекційного захворювання. Біль у животі в більшості випадків обумовлений хронічними захворюваннями органів травлення або функціональними розладами. Педіатри, лікарі загальної практики та гастроентерологи частіше зустрічаються з рецидивуючим болем у животі (довготривалий переривчастий або постійний біль). Рецидивуючий біль у животі у дітей визначається як три епізоди болю, що відбуваються протягом трьох місяців і впливають на нормальну активність дитини. Погоджувальний документ Американської педіатричної асоціації та Північноамериканської асоціації дитячої гастроентерології, гепатології та харчування в 2005 році запропонував використовувати замість терміну «рецидивуючий біль у животі» термін «хронічний абдомінальний біль». Хронічний абдомінальний біль найчастіше (90–95 % випадків) вважається функціональним (неорганічним) болем у животі без об’єктивних ознак основного органічного розладу і характеризується різноманіттям проявів. За механізмом виникнення виокремлюють вісцеральний, парієтальний (соматичний), іррадиюючий та психогенний біль. При болі в животі необхідно оцінити: час появи, інтенсивність, характер, тривалість, локалізацію. На першому етапі діагностики необхідно виключити гостру хірургічну патологію. Про високу ймовірність хірургічної патології свідчать «симптоми тривоги». На наступному етапі проводиться диференційна діагностика органічних та функціональних причин абдомінального болю. При всіх видах функціонального болю відзначають порушення вісцеральної моторики і розвиток спазмів. Скорочувальна активність гладких м’язів ініціюється парасимпатичною нервовою системою. Лікування рецидивуючого болю в животі направлено на усунення його причин: зняття спазму, нормалізацію моторики шлунково-кишкового тракту. На даний час серед різних груп спазмолітиків при лікуванні функціональних розладів травного тракту віддають перевагу селективним міотропним спазмолітикам. Серед них мебеверин є оптимальним за ефективністю та безпекою. Мебеверин блокує швидкі натрієві канали, розташовані на клітинній мембрані міоцитів, перешкоджаючи надходженню іонів натрію в клітину. Цей механізм призводить до послаблення скорочувальної функції гладком’язового волокна і сприяє усуненню спазму, але не викликає гіпотонії. На відміну від антихолінергічних препаратів мебеверин справляє селективну дію на гладкі м’язи травного тракту. У клінічній практиці заслуговує на увагу мебеверину гідрохлорид — Спарк® (ПАТ «Фармак»), при прийомі якого відзначається збереження нормального тонусу і перистальтики після купірування м’язового спазму. Препарат Спарк® випускається в капсулах, одна капсула містить 200 мг мебеверину гідрохлориду. Згідно з інструкцією мебеверин (Спарк®) призначається дорослим і дітям від 10 років по 1 капсулі два рази на добу. Препарат не має системної дії. Застосування мебеверину (Спарк®) патогенетично обґрунтовано для лікування захворювань, що перебігають з абдомінальним больовим синдромом у дорослих і дітей старше 10 років.

Do children with recurrent abdominal pain grow up to become adolescents who control their weight by fasting? Results from a UK population-based cohort.

Gastrointestinal (GI) problems are common in eating disorders, but it is unclear whether these problems predate the onset of disordered eating. Recurrent abdominal pain (RAP) is the most prevalent GI problem of childhood, and this study aimed to explore longitudinal associations between persistent RAP (at ages 7 and 9) and fasting for weight control at 16. The Avon Longitudinal Study of Parents and Children (ALSPAC) is a UK population cohort of children. Childhood RAP was reported by mothers and defined as RAP 5+ (5 pain episodes in the past year) in our primary analysis, and RAP 3+ (3 pain episodes) in our sensitivity analysis. Fasting for weight control was reported by adolescents at 16. We used logistic regression models to examine associations, with adjustments for potential confounders. After adjustments, we found no association between childhood RAP 5+ and adolescent fasting for weight control at 16 (OR 1.30 (95% Confidence Intervals [CI] 0.87, 1.94) p=.197). However, we did find an association between RAP 3+ and later fasting, in the fully adjusted model (OR 1.50 [95% CI 1.16, 1.94] p=.002), and after excluding those with pre-existing anxiety (OR 1.52 [95% CI 1.17, 1.97] p=.002). Our findings suggest a possible independent contribution of RAP to later risk of fasting for weight control, and RAP should be enquired about in the assessment of eating disorders. However, frequency of childhood abdominal pain (as captured by ALSPAC) may be less important to long-term outcomes than functional impairment.

Helicobacter Pylori Infection with Recurrent Abdominal Pain in Children

Background: Childhood Recurrent Abdominal Pain results in the one of the adulthood complications i.e., irritable bowel syndrome, which is a gastro-intestinal disease. The stomach’s acidic environment is the growth site for Helicobacter Pylori, a pathogenic Gram-negative bacterium with rod shape. It is the main reason for chronic gastritis, gastric adenocarcinoma, peptic ulcers, non-ulcer dyspepsia and mucosa-associated lymphoid tissue (MALT) lymphoma. According to one estimate, 50% of people in world are infected with Helicobacter Pylori. Currently the developing countries are on the hit list of Helicobacter Pylori. The objective of this study was to determine the frequency of Helicobacter pylori infection in the children having recurrent abdominal pain. Materials and Methods: It was a cross-sectional study. This research was carried out during 1.1.2018 to 1.6.2018 in the D.H.Q hospital Mirpur AJK. The sample was consisted of 200 participants among them the proportion of Helicobacter was 8% in patients with Recurrent Abdominal Pain. Results: The mean age of the patients was 12.43 ± 1.23 years. Mostly the age of the sample group was between 8 to16 years. The 4.23 ± 0.47 months was the mean time period of abdominal pain. Helicobacter pylori was found in 47% of patients. Conclusion: In paediatric population, Helicobacter pylori is very common with Recurrent Abdominal Pain. It is a severe problem in children and further study is recommended to explore the risk element associated with this increase trouble of Helicobacter Pylori.

Giant mesenteric lymphangioma

Abstract Mesenteric lymphagiomas are cystic lesions and therefore called mesenteric cysts. They are benign tumors of the lymphatic system, with low incidence in the general population, and even lower in the pediatric population. The clinical presentation is quite variable raging from incidentally found or even as a cause of acute abdomen. This study reports the rare case of giant mesenteric lymphangioma in a child with complaints of recurrent abdominal pain, referred to the pediatric hepatology service for ascites investigation, identified on physical examination and confirmed on abdominal ultrasound. On admission, a abdominal computed tomography was requested, revealing a massive cystic formation, which occupied the lower two-thirds of the abdomen. The patient underwent exploratory laparotomy, upon which a large mesenteric cyst in the jejunum was visualized. The histological analysis of the cyst revealed findings are compatible with lymphangioma. After surgical procedure, the patient maintained a good clinical evolution, with complete resolution of abdominal pain. Although rare, mesenteric lymphangioma should be included in the differential diagnosis list of gastrointestinal symptoms and recurrent abdominal pain in children. In addition, there may be initial confusion with ascites when there are large-volume tumors.

Prevalence and Progression of Recurrent Abdominal Pain, From Early Childhood to Adolescence

Little is known about the natural history of childhood recurrent abdominal pain (RAP). We investigated the prevalence and progression of childhood RAP and its association with Rome III abdominal pain-related functional gastrointestinal disorders (AP-FGID) and irritable bowel syndrome (IBS) during adolescence. We collected data from a prospective population-based birth cohort study of 4089 children, born from 1994 through 1996 in Sweden. We analyzed data from 2455 children with complete follow-up evaluation at ages 1, 2, 12, and 16 years and no parent-reported diagnoses of inflammatory bowel diseases or celiac disease at ages 12 or 16 years. A subpopulation of 2374 children who had answered questions based on the Rome III criteria at age 16 years was identified. We assessed RAP at 3 assessment points and defined it as parent-reported attacks of colic in early childhood (1-2 years) and as self-reported weekly abdominal pain at ages 12 years and 16 years. AP-FGID at age 16 years was defined according to the Rome III criteria. RAP was reported by 26.2% of children on at least 1 of 3 assessment points, of which 11.3% reported symptoms more than once. Children with RAP at 12 years had persistent symptoms at 16 years in 44.9% of cases and increased risks for RAP (relative risk, 2.2; 95% CI, 1.7-2.8), any AP-FGID (relative risk, 2.6; 95% CI, 1.9-3.6), and IBS (relative risk, 3.2; 95% CI, 2.0-5.1) at 16 years. Early childhood RAP was not associated significantly with any outcome. RAP affects many children from early childhood through age 16 years, but most children do not have persistent symptoms throughout childhood. RAP at age 12 years is a risk factor for RAP, any Rome III AP-FGID, and IBS, at age 16 years.

Recurrent abdominal pain in children attending pediatrics OPD

Background: Recurrent abdominal pain is one of the commonest gastrointestinal complaints in children, affecting approximately 10% of school-aged children and adolescents. There is no consensus with regards to etiology, investigation, and management of this common problem. This article addresses some of the issues related to epidemiology, etiology, management, and prognosis of recurrent abdominal pain. Material and Methods: This was a hospital-based study conducted on 120 children patients with RAP. Patients of the age group of 4 to 14 years attending the pediatric OPD of Indian Institute of Medical Science and Research and Noor Hospital, from January 2019 to November 2019 were included in the study. Children age less than 4 years and more than 13 years not meeting the criteria of RAP were excluded from the study. Children with organic causes of RAP have been treated according to the corresponding reason. Results: Out of 120 patients of RAP, sex distribution is unequal with male predominance (64.1%). Although in this study, age group was in the following order by decreasing 7-10 years old (43.3%), followed by 4-6 years old (36.3%) and 11-14 years old (20%). Conclusions: Organic disorder is still the commoner causes of RAP in our part of the world. Most children with recurrent abdominal pain have functional gastrointestinal diseases and detailed history, examination and basic stool, urine and hematological investigations are sufficient to exclude organic pathology in them. The key step in the management of RAP is to first investigate for the organic cause based on the symptoms and then treat.

Study of recurrent abdominal pain in children of south Karnataka

Study of recurrent abdominal pain in children of south Karnataka

Study of Recurrent Abdominal Pain in Children of Telangana

83 school going children aged between 6–15 years of both sexes were studied for Recurrent abdominal pain (RAP) the height of 49 (59%) children was the 148 to 150 cm, 34(40.9) children was 151 to 157 cms. The weight of the 47(56.6%) of children was 42 to 44 kg and 36(43.3%) children had 45 to 48 kg weight BMI of 46 (55.4%) children has 18.2 to 19.2, 37 (44.5%) had 19.3 to 20.2. The dietary habit of children 16(19.2%) were purely vegetarian, 18 (21.6%) were non vegetarian, 49(59%) were both vegetarian and non-vegetarians. The clinical manifestation were 16(19.2%) had constipation, 19(22.8%) had mesenteric lymphadenopathy, 14(16.8%)had urinary tract infection, 24(28.9%) had pallor, 6(7.22%) had hapotomegaly, 4(4.81%) had splenomegaly.

Dietary interventions for recurrent abdominal pain in childhood.

Dietary interventions for recurrent abdominal pain in childhood.

Recurrent abdominal pain and upper gastrointestinal endoscopy findings in children and adolescents presenting at the Lagos University Teaching Hospital.

IntroductionRecurrent abdominal pain (RAP) is a common reason for referral to the paediatric gastroenterology unit and the attending physician needs to be able to rule out an organic cause when evaluating any child with this condition. The aim of this study was to describe the endoscopic findings in children who presented to the paediatric gastroenterology unit of the Lagos University Teaching Hospital (LUTH) with RAP.MethodsThis was a prospective descriptive study which was conducted from January 2015 to July 2018 at the Paediatric Gastroenterology unit of the department of Paediatrics and the endoscopy unit of the LUTH, Lagos, Nigeria. All children and adolescents ≤ 19 years old with recurrent abdominal pain who were referred for upper GI endoscopy during the study period, were recruited. Baseline sociodemographic data, dyspepsia and alarm symptoms if present were documented. Results of other investigations namely stool examination for ova, parasites, occult blood and faecal antigen for Helicobacter pylori and abdominal scan were also documented.ResultsA total of 113 children with recurrent abdominal pain was referred during the study period and 87 (76.7%) of them had upper GI endoscopy done. Out of the participants, 38(43.7%) were boys and 49(56.3) girls. Alarm features were present in 15(17.6%) and dyspepsia was seen in 22(25.3%) of the subjects. The main endoscopic findings were: gastritis in 39 (44.8%), gastric erosions in 14(16.2%), hiatus hernia in 7(8.1%), duodenitis in 6 (6.9%), gastric polyp in 4 (4.6%).ConclusionUpper GI endoscopy remains an invaluable tool in the tool in evaluating RAP in children as it enables accurate diagnosis of GI causes of RAP. There is a need to advocate for easier access to this procedure in the developing countries.