From the Guidelines
Pediatric patients have distinct upper GI issues compared to adults, primarily due to a higher prevalence of eosinophilic oesophagitis (EoE) and Crohn's disease (CD) in the upper GI tract.
Key differences in upper GI issues between pediatric and adult patients
- Eosinophilic oesophagitis (EoE): Children with upper GI symptoms should have biopsies taken to diagnose EoE, as the macroscopic endoscopic appearances are not a reliable predictor of EoE in this age group 1. In contrast, adults with typical gastro-oesophageal reflux disease (GORD) symptoms refractory to proton pump inhibitors (PPIs) do not typically require endoscopy and biopsies to exclude EoE, unless they have clinical features suggestive of EoE such as dysphagia and atopy 1.
- Crohn's disease (CD): CD affects the upper GI tract more commonly in children than in adults, with 30% of children having macroscopic upper GI disease either isolated or together with the involvement of other intestinal segments 1. However, the need for surgery does not seem to be increased in pediatric patients with upper GI CD.
Diagnosis and management of upper GI issues in pediatric patients
- Endoscopy and biopsies: All children undergoing endoscopy for upper GI symptoms should have biopsies taken to diagnose EoE, and those with typical GORD symptoms refractory to PPIs should undergo oesophago-gastro-duodenoscopy (OGD) with sufficient oesophageal biopsies to exclude EoE 1.
- Medical management: The medical management of pediatric Crohn's disease should be individualized based on risk and benefit, taking into account the more aggressive disease course and greater propensity for disease extension in children compared to adults 1.
From the Research
Distinct Upper GI Issues in Pediatric Patients
The distinct upper GI issues in pediatric patients compared to adults can be categorized into several areas, including:
- Infectious, inflammatory, and immunologic pathology
- Motility disorders
- Functional gastrointestinal disorders 2 These categories can help in distinguishing various diagnoses in pediatric patients.
Upper GI Tract Involvement in Pediatric IBD
Upper GI tract involvement is commonly seen in pediatric patients with inflammatory bowel disease (IBD) 3, 4. The frequency and significance of upper GI findings in pediatric IBD patients are more common than in controls, particularly in the stomach and duodenum 3. Histologic confirmation of upper GI tract involvement can aid in confirming the diagnosis of IBD and its classification 4.
Comparison of GI Symptoms in Pediatric Patients
Pediatric patients with functional GI disorders (FGIDs) report more GI symptoms and worry than patients with organic GI diseases 5. The PedsQL Gastrointestinal Symptoms and Worry Scales can be used to measure GI-specific symptoms in clinical research and practice, distinguishing between pediatric patients with FGIDs and organic GI diseases in comparison with healthy controls 5.
Therapeutic Upper GI Endoscopy in Pediatric Gastroenterology
Therapeutic upper GI endoscopy is increasingly available to pediatric endoscopists and their patients, allowing for the treatment of various pediatric upper GI pathologies, acquired or congenital 6. This highlights the importance of considering the unique needs and conditions of pediatric patients in the diagnosis and treatment of upper GI issues.