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Changing Indications for Upper Endoscopy in Children During a 20-year Period

Franciosi, James P*; Fiorino, Kristin; Ruchelli, Eduardo||; Shults, Justine; Spergel, Jonathan; Liacouras, Chris A; Leonard, Mary§

Journal of Pediatric Gastroenterology & Nutrition: October 2010 - Volume 51 - Issue 4 - p 443–447
doi: 10.1097/MPG.0b013e3181d67bee
Original Articles: Gastroenterology

Objectives: In parallel with the increase in pediatric esophagogastroduodenoscopy (EGD) procedures since the 1970s, the incidence of disorders that require EGD for diagnosis in children has increased. The aim of this study was to identify changes in subject characteristics and endoscopic procedures during a 20-year interval in children undergoing EGD at a single center.

Patients and Methods: All of the children undergoing first EGD with biopsy in 1985, 1995, or 2005 were identified. Details of the clinical presentation and EGD were abstracted from medical records in a random sample of subjects within each time point.

Results: The number of first-time EGDs rose dramatically from 107 in 1985 to 1294 in 2005. The proportion of subjects that were younger than 1 year of age varied significantly from 13% in 1985 to 23% in 1995 and 8% in 2005 (P < 0.001). The proportion of subjects with gastrointestinal (GI) bleeding declined from 34% to 5% during the 20-year interval (P < 0.001), whereas the proportion with abdominal pain increased from 23% to 43% (P < 0.01). During the same interval, the proportion of subjects with complete EGD (biopsies from the esophagus, stomach, and duodenum) increased from 18% of EGDs in 1985 to 95% in 2005 (P < 0.001).

Conclusions: This study of children undergoing first-time EGDs with biopsy during a 20-year interval demonstrated significant differences in subject characteristics and endoscopy practices. The inclusion of children with less severe clinical presentation and the collection of greater numbers of biopsies per procedure may contribute to the rising incidence rates of pediatric GI disorders.

*Cincinnati Children's Hospital Medical Center, Division of Gastroenterology, Hepatology and Nutrition, USA

the Children's Hospital of Philadelphia, Division of Gastroenterology, Hepatology and Nutrition, USA

Division of Allergy and Immunology, USA

§Division of Nephrology, USA

||Department of Pathology, Cincinnati, OH, USA

University of Pennsylvania, Clinical Center for Epidemiology and Biostatistics, Philadelphia, PA, USA.

Received 20 March, 2009

Accepted 23 December, 2009

Address correspondence and reprint requests to James P. Franciosi, MD, MS, MSCE, Cincinnati Children's Hospital Medical Center, Division of Gastroenterology, Hepatology and Nutrition, 3333 Burnet Ave, ML 2010, Cincinnati, OH 45229 (e-mail:

The present study was supported by a grant from NIH T32-DK007740, “Clinical Epidemiology Training in Gastroenterology.”

The authors report no conflicts of interest.

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