Recurrent abdominal pain in children: the utility of upper endoscopy and histopathology

N Ukarapol, N Lertprasertsuk, L Wongsawasdi
Correspondence: Dr Nuthapong Ukarapol, nukarapo@mail.med.cmu.ac.th

ABSTRACT
Introduction To study the utility of upper gastrointestinal endoscopy with biopsy in the evaluation of children with clinically-significant recurrent abdominal pain.
Methods Over a three-month period, children with three or more episodes of upper abdominal pain that was severe enough to impair their normal activity and required medical attention were included in the study. After complete history, physical examination and basic investigations, upper gastrointestinal endoscopy with biopsy was performed in all patients.
Results Thirty-eight children were enrolled. Their average age was 10.5 years and 21 were female. Organic causes were identified in 44.7 percent of the cases, with Helicobacter pylori gastritis being the most common diagnosis (28.9 percent). No specific dyspeptic symptom was significantly associated with either organic cause of recurrent abdominal pain or Helicobacter pylori infection. Antral nodularity was the only endoscopic finding significantly associated with Helicobacter pylori infection (sensitivity 63.4 percent, specificity 85.2 percent). All patients improved after specific therapy was instituted.
Conclusion The organic causes of recurrent abdominal pain in children have been increasingly identified in our hospital, a tertiary care centre in Northern Thailand. One of the most common causes found in this study was Helicobacter pylori infection. Upper endoscopy was very helpful in identifying the underlying pathology.

Keywords: abdominal pain, children, endoscopy, Helicobacter pylori, recurrent abdominal pain
Singapore Med J 2004; 45(3): 121-124