Hyams J S, Davis P, Sylvester F A, Zeiter D K, Justinich C J, Lerer T
Division of Digestive Diseases and Nutrition, Connecticut Children's Medical Center, Hartford 06106, USA.
J Pediatr Gastroenterol Nutr. 2000 Apr;30(4):413-8. doi: 10.1097/00005176-200004000-00012.
Dyspepsia is poorly characterized in the pediatric population. The goal of the current study was to describe the clinical constellation and natural history of dyspepsia in children and adolescents seen in a pediatric gastroenterology practice.
A standardized questionnaire was administered by a pediatric gastroenterologist to all subjects 5 or more years of age (and their parents or guardians) treated in a referral pediatric gastroenterology practice for 1 month or more of abdominal pain or discomfort, nausea, or vomiting. Subjects with dyspepsia and dyspepsia subtypes (ulcer-like, dysmotility-like) were identified by using previously defined adult criteria. Evaluation and treatment were performed at the discretion of the attending pediatric gastroenterologist.
During a 1-year period, 257 patients were screened with 127 subjects fulfilling criteria for dyspepsia (59% girls, 85% white; median age, 11.7 years; median duration of symptoms, 8 months). Symptoms were ulcer-like in 26% and dysmotility-like (nausea predominance) in 15% of subjects. In those with dyspepsia, irritable bowel syndrome and gastroesophageal reflux were noted in 24% and 43%, respectively. Esophagogastroduodenoscopy and biopsy were performed in 56 subjects with 21 (38%) having mucosal inflammation (Helicobacter pylori in 5). The remaining 35 subjects (62%) were considered to have functional dyspepsia. Duration of symptoms less than 1 year and vomiting were risk factors for mucosal inflammation. Follow-up at 6 months to 2 years revealed 70% of subjects were either asymptomatic or much improved regardless of the cause of dyspepsia.
Most children and adolescents with dyspepsia do not have serious disease. In our referral population H. pylori infection was unusual, and no peptic ulceration was found. Most subjects with functional dyspepsia have improvement of symptoms over time.
消化不良在儿科人群中的特征尚不明确。本研究的目的是描述在儿科胃肠病科就诊的儿童和青少年消化不良的临床症状群及自然病程。
由儿科胃肠病学家向所有5岁及以上（及其父母或监护人）在儿科胃肠病转诊科室接受治疗1个月或更长时间的腹痛或不适、恶心或呕吐的患者发放标准化问卷。根据先前定义的成人标准确定消化不良患者及消化不良亚型（溃疡样、动力障碍样）。评估和治疗由主治儿科胃肠病学家酌情进行。
在1年期间，共筛查了257例患者，其中127例符合消化不良标准（女孩占59%，白人占8%；中位年龄11.7岁；症状中位持续时间8个月）。26%的患者症状为溃疡样，15%为动力障碍样（以恶心为主）。在消化不良患者中，分别有24%和43%的患者伴有肠易激综合征和胃食管反流。对56例患者进行了食管胃十二指肠镜检查及活检，其中21例（38%）有黏膜炎症（5例有幽门螺杆菌感染）。其余35例（62%）被认为患有功能性消化不良。症状持续时间小于1年和呕吐是黏膜炎症的危险因素。随访6个月至2年发现，无论消化不良的病因如何，70%的患者无症状或症状明显改善。
大多数患有消化不良的儿童和青少年没有严重疾病。在我们的转诊人群中，幽门螺杆菌感染并不常见，也未发现消化性溃疡。大多数功能性消化不良患者的症状会随时间改善。
