What information is needed in a referral for a pediatric patient with recurrent epigastric pain diagnosed with Acid Related Disease being referred to Gastroenterology (GI)?

Essential Information for Pediatric Referral to GI for Acid-Related Disease

A comprehensive pediatric GI referral for recurrent epigastric pain diagnosed as Acid-Related Disease should include detailed symptom characteristics, response to previous treatments, relevant medical history, and any warning signs that may indicate more serious conditions. 1, 2

Core Clinical Information Required

Symptom Details

• Pain characteristics:

  • Duration and frequency of epigastric pain episodes
  • Pain intensity (using age-appropriate pain scale)
  • Timing of pain in relation to meals
  • Specific location and radiation of pain
  • Aggravating and alleviating factors

• Associated symptoms:

  • Presence of heartburn/regurgitation
  • Vomiting (frequency, timing, content)
  • Dysphagia or food impaction episodes
  • Weight changes (loss or poor weight gain)
  • Sleep disturbances related to symptoms 1

Treatment History

• Previous interventions:
  • Response to conservative measures (dietary modifications, positioning)
  • Trial of acid suppression therapy (medication name, dose, duration)
  • Response to PPI therapy (complete, partial, or no response)
  • Compliance with previous treatments 1, 2

Medical History

• Relevant history:
  • Growth parameters (height, weight, BMI percentiles)
  • Allergic conditions (asthma, eczema, food allergies)
  • Family history of GI disorders
  • Dietary habits and recent changes 1, 2

Warning Signs/Red Flags to Document

• Concerning symptoms requiring urgent evaluation:
  • Dysphagia or food impaction episodes
  • Hematemesis or melena
  • Persistent vomiting
  • Weight loss or failure to thrive
  • Nocturnal symptoms disrupting sleep 1, 2

Diagnostic Testing Already Completed

• Previous investigations:
  • Results of any prior endoscopy or imaging studies
  • Laboratory findings (CBC, liver function tests, etc.)
  • Previous H. pylori testing results 1

Specific Considerations by Age Group

Infants and Young Children

• Document feeding difficulties, irritability during/after feeding
• Note any history of recurrent regurgitation or dystonic neck posturing 1, 3

School-Age Children and Adolescents

• Document presence of heartburn/epigastric pain
• Note any history of food impaction or dysphagia
• Include impact on daily activities and school attendance 1

Pitfalls to Avoid in Referrals

1. Inadequate treatment trial documentation: Clearly document duration, dosage, and response to PPI therapy, as inadequate trials may lead to unnecessary testing 1

2. Missing red flags: Always document presence/absence of warning signs that may indicate conditions requiring urgent evaluation 1

3. Overlooking differential diagnoses: Consider and document evaluation for other causes of recurrent abdominal pain (functional disorders, eosinophilic esophagitis) 1, 4

4. Insufficient symptom characterization: Vague descriptions like "stomach pain" are insufficient; provide detailed symptom characteristics 1

Remember that proper documentation in the referral will help the gastroenterologist determine the appropriate evaluation strategy and potentially reduce unnecessary testing for the pediatric patient with acid-related disease.