Altepeter Tara A, Shaffer Stephen
*US Food and Drug Administration, Center for Drug Evaluation and Research, Division of Gastroenterology and Inborn Errors Products, Silver Spring, MD †Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE.
J Pediatr Gastroenterol Nutr. 2017 Jul;65(1):22-25. doi: 10.1097/MPG.0000000000001440.
The aim of the study was to quantify the diagnostic yield of upper endoscopy in children with gastroparesis and to develop a clinical model for gastroparesis using common symptoms and screening blood tests.
We retrospectively reviewed charts of 196 patients of age 4 to 18 years evaluated for gastroparesis between 2009 and 2013. All patients completed a standard solid-phase gastric emptying scan and upper endoscopy within a 12-month period. We analyzed gross and histologic endoscopy findings. Symptom-based data were collected on dyspeptic symptoms and classic "red-flag" symptoms.
Seventy patients with gastroparesis and 126 controls were included. Clinically significant endoscopic findings were noted in 35% of controls (44/126) and 43% of gastroparetics (30/70), P = 0.345. Concordance between gross and histologic findings was low at 50%. Histologic findings included gastritis 60% (17/28), esophagitis 39% (11/28), and duodenitis 7% (2/28). In univariate and multivariate analyses, there was no meaningful correlation between symptoms and/or screening laboratory values and diagnosis of gastroparesis.
Clinically significant endoscopy findings were common in both controls and gastroparetics. As more than one-third of patients had findings on endoscopy, we conclude that upper endoscopy remains an important part of the evaluation process of patients with dyspeptic symptoms and suspected gastroparesis. As gross abnormalities were frequently not present with histologic changes, routine biopsy is required. There was no association between studied symptoms and the presence of gastroparesis. A comprehensive evaluation of children with dyspeptic symptoms requires endoscopy with biopsy and solid-phase gastric emptying scan to determine the underlying diagnosis.
本研究旨在量化上消化道内镜检查对胃轻瘫患儿的诊断价值，并利用常见症状和筛查血液检查建立胃轻瘫的临床模型。
我们回顾性分析了2009年至2013年间接受胃轻瘫评估的196例4至18岁患者的病历。所有患者在12个月内完成了标准的固相胃排空扫描和上消化道内镜检查。我们分析了内镜检查的大体和组织学结果。收集了基于症状的消化不良症状和典型“警示”症状的数据。
纳入70例胃轻瘫患者和126例对照。35%的对照（44/126）和43%的胃轻瘫患者（30/70）有具有临床意义的内镜检查结果，P = 0.345。大体和组织学结果之间的一致性较低，为50%。组织学结果包括胃炎60%（17/28）、食管炎39%（11/28）和十二指肠炎7%（2/28）。在单变量和多变量分析中，症状和/或筛查实验室值与胃轻瘫的诊断之间没有有意义的相关性。
具有临床意义的内镜检查结果在对照和胃轻瘫患者中都很常见。由于超过三分之一的患者在内镜检查中有发现，我们得出结论，上消化道内镜检查仍然是消化不良症状和疑似胃轻瘫患者评估过程的重要组成部分。由于大体异常经常不存在于组织学变化中，因此需要进行常规活检。所研究的症状与胃轻瘫的存在之间没有关联。对消化不良症状患儿进行全面评估需要内镜检查及活检和固相胃排空扫描以确定潜在诊断。
