Objective: Pediatric Rome III criteria of functional dyspepsia (FD) has eliminated the mandatory use of upper endoscopy and recommended a symptom-based approach. In the absence of alarm symptoms, FD can be positively diagnosed in children having normal physical findings without exclusionary investigations. We aimed to investigate the effectiveness of Rome III guidelines to discriminate organic diseases from FD and to identify the predictors for positive endoscopic findings.
Patients and Methods: A prospective study was conducted on consecutive children fulfilling Rome III criteria of FD. Upper endoscopy was performed in all subjects, both with and without alarm features.
Results: Eighty consecutive children ages 7 to 15 were recruited. Nine (11.3%) had experienced alarm features. Five (6.3%) had organic diseases confirmed in upper endoscopy: duodenal ulcer (n = 2), duodenitis with erosion (n = 2), and gastritis with erosion (n = 1), 33.3% of children having alarm features had organic pathology, compared with 2.8% of those without (P < 0.01). A male predominance (80% vs 25.3%, P < 0.01), higher prevalence of alarm features (60% vs 8%, P < 0.01), and higher prevalence of Helicobacter pylori infection (80% vs 5.3%, P < 0.01) were found in children with organic diseases, compared with FD. Multivariate analysis identified H pylori infection (odds ratio 23.2; 95% confidence interval 1.5–333) and nocturnal pain (odds ratio 26.3; 95% confidence interval 1.2–500) to be independent predictors for positive endoscopic findings.
Conclusions: Rome III recommendations of screening dyspeptic children for alarm features and investigation for H pylori are effective to identify children who have a higher likelihood of organic diseases and require upper endoscopy before making a diagnosis of FD.
*Division of Paediatric Surgery & Paediatric Urology, Department of Surgery, China
†Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China.
Received 3 October, 2010
Accepted 26 December, 2010
Address correspondence and reprint requests to Dr Y.H. Tam, Division of Paediatric Surgery & Paediatric Urology, Department of Surgery, Prince of Wales Hospital, Shatin, NT, Hong Kong, China (e-mail: firstname.lastname@example.org).
The study was supported by the Department of Surgery and the Chinese University of Hong Kong.
The authors report no conflicts of interest.