Introduction: Recurrent abdominal pain is one of the most common complaints in the pediatric population.The prevelence of organic disease responsible for the pain has ranged from 10–50%. In chronic inflammation of the gut the endoscopic appearance does always predict histological alterations.
The aim of the study was to evaluate the prevalence of the duodenitis in patients with recurrent abdominal pain, with normal endoscopic appearance of forgut mucosa.
Methods: 69 children, 38 girls, mean age 13y, range 6 – 18y referred to our department for recurrent abdominal pains were studied. Upper intestinal endoscopy was performed as a part of staging procedure and biopsy samples were taken for histology from the duodenum and the stomach. Children with endoscopically confirmed gastritis or duodenitis, Helicobacter pylori infection, food allergy and other chronic disease were excluded from the study.
Control group consisted of 19 children, 10 girls, mean age 12y, without abdominal problems, referred for gastroscopy due to short stature.
All biopsy specimens were evaluated by one pathologist, blinded to the clinical and endoscopic data. Chronic inflammatory cells, polymorphonuclear neutrophils, eosinophils were recorded and each of these variables was graded mild, moderate or marked.
Immunochemistry was performed using antihuman T cell CD3, CD8( Dako). Mast cells were identified using a monoclonal antibodies against mast cell tryptase (Dako)
Results: The mean time of abdominal complaints was 21 month ±12,9
The endoscopy was macroscopically normal in all cases. Duodenitis was diagnosed in 48 (69.5%) patients: 23 grade 1, 24 grade 2, and 1 grade 3. In this group CD3 lymphocytes number /per mm2 was significantly higher than in controls ( 127±68 v 79±54, p= 0.00228). There was no correlation between severity of inflammation and age of patients and duration of symptoms, but a significant correlation was found between duration of complaints and number mast cells ( p=0.03). In controls duodenitis was presented in two cases: one grade 1 and one grade 2. There were no differences between the two groups regarding number of mast cells and eosinophils, although in subjects with abdominal pains the number of CD8 lymphocytes was decreased (p=0,0415) as compared to controls.
Conclusion: Nonspecific duodenitis is a common finding in childern with recurrent abdominal pain.Histopathological examination of biopsy samples is essential in the diagnosis of children with RAP, because it has the potential to significantly enhance the accuracy of clinical diagnosis.