Objectives: The objective of the study was to ascertain the appropriateness of indications for upper gastrointestinal (UGI) endoscopy in children with dyspepsia.
Methods: We used the RAND/University of California at Los Angeles method to investigate the appropriateness of the opinions of a panel of experts. The panel judged 2304 theoretical patient scenarios defined by a combination of demographic and clinical variables. Descriptive and multivariate logistic regression analyses were performed.
Results: The panel rated UGI endoscopy as appropriate in 27.2% of cases, inappropriate in 14.3%, and dubious in 58.5%. Disagreement emerged for 21% of cases. UGI endoscopy was considered increasingly appropriate in cases with a positive family history of peptic ulcer and/or Helicobacter pylori infection (odds ratio [OR] 8.518, P < 0.0001), when dyspepsia interfered with activities of daily living (“sleep” OR 7.540, P < 0.0001; “normal activities” OR 5.725, P < 0.0001), and when patients were older than 10 years (“≤10 years” OR 0.310, P < 0.0001) the longer the duration (“0–2 months” OR 0.002, P < 0.0001; “3–5 months” OR 0.059, P < 0.0001; “6–11 months” OR 0.516, P = 0.0005) and the greater the severity (“mild” OR 0.002, P < 0.0001; “moderate” OR 0.013, P < 0.0001) of their dyspeptic symptoms.
Conclusions: UGI endoscopy is not appropriate for all children with dyspeptic symptoms, but only for cases with a family history of peptic ulcer and/or Helicobacter pylori infection, older than 10 years of age, with symptoms persisting for more than 6 months and severe enough to affect activities of daily living.
*Gastroenterology and Endoscopy Unit, Italy
†Epidemiology and Community Medicine Unit, Department of Pediatrics, University of Padua, Padua, Italy
‡Pediatric Gastroenterology and Endoscopy Unit, University of Messina, Messina, Italy
§Gastrointestinal Surgery and Endoscopy Unit, Ospedale Pediatrico Bambino Gesù, Rome, Italy
||Pediatric Gastroenterology and Endoscopy Unit, General Hospital, Pescara, Italy
¶private practice, Treviso, Italy
#Department of Pediatrics, University of Ferrara, Ferrara, Italy
**Department of Pediatrics, University of Foggia, Foggia, Italy
††private practice, Italy
‡‡Pediatric Unit, General Hospital, Venice, Italy.
Received 8 September, 2008
Accepted 31 July, 2009
Address correspondence and reprint requests to Prof G. Guariso, Department of Pediatrics, Via Giustiniani, 3, 35128 Padova, Italy (e-mail: firstname.lastname@example.org).
The authors report no conflicts of interest.