Saudi Journal of Gastroenterology
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Year : 1996  |  Volume : 2  |  Issue : 1  |  Page : 15-18
Pattern of pediatric upper gastrointestinal disease: A teaching hospital experience

1 Department of Pediatrics, King Fahd Hospital of the University, Alkhobar, Saudi Arabia
2 Department of Internal Medicine, King Fahd Hospital of the University, Alkhobar, Saudi Arabia

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During the period 1983-1993, 166 pediatric patients(91 females and 75 males) were subjected to upper gastrointestinal endoscopy. Epigastric pain or heart burn and vomiting were the indications in 115 (69 %)patients. Gastritis. duodenitis, and esophagitis were diagnosed in 63 (38 %), and duodenal ulcer in seven (4.2%)patients. Bleeding sites were identified in 10 out of 21 (47.6% )patients with a history of hematemesis. Helicobacter pylori was identified in 12 (48%) of 25 patients with chronic gastritis. Endoscopic removal of foreign bodies (FB) was required in nine patients. Endoscopic small bowel biopsy provided sufficient material to con­firm the diagnosis in seven out of 13 patients with chronic diarrhea. Endoscopic findings were normal in 78 (47%)patients. The procedure was safe and well tolerated.

How to cite this article:
Lardhi A, Al Sultan A, Saleh M A, Al Quorain A, Adel A, Al Baradie R. Pattern of pediatric upper gastrointestinal disease: A teaching hospital experience. Saudi J Gastroenterol 1996;2:15-8

How to cite this URL:
Lardhi A, Al Sultan A, Saleh M A, Al Quorain A, Adel A, Al Baradie R. Pattern of pediatric upper gastrointestinal disease: A teaching hospital experience. Saudi J Gastroenterol [serial online] 1996 [cited 2022 Jun 25];2:15-8. Available from:

Upper gastrointestinal (UGI) endoscopy has become a corner stone in the diagnosis and man­agement of gastrointestinal diseases. Since it was introduced in pediatric practice, the experience gained over the last three decades, along with the development of special pediatric endoscopes have alleviated the concerns about its safety in children [1],[2],[3],[4],[5],[6],[7] . The direct visualization of different sites, with the facility to obtain histological materials, makes endoscopy superior to other gastrointesti­nal diagnostic procedures [5],[8],[9] . The aim of this communication is to present our analysis of com­mon upper gastrointestinal disorders seen at King Fahd Hospital of the University.

   Patients and methods Top

The medical records of all pediatric patients, subjected to UGI endoscopy at King Fahd Hospi­tal of the University, Al-Khobar, Saudi Arabia, during the period January 1983 to December 1993,were retrieved and retrospectively analyzed.

The endoscopic procedure was performed gen­erally under basal sedation using olympus-pediat­ric gastroduodenoscope (GIF-XP). In some infants and older children, general anaesthesia was required, average duration was 15-20 minutes. A biopsy was taken where indicated and feasible. Based on the indications, patients were classified into five groups: Group A: patients with epigastric pain, heart burn and vomiting. Group B: patients with hematemesis. Group C:patients with chronic diarrhea/malabsorption syndrome. Group D: patients with history of FB ingestion. Group E: patients with other conditions.

   Results Top

There were 166 patients, of which 88% are Saudis, 91 females (54.8%)and 75 males (45.2%) with a mean age of 11.4 ± 4.6 SD (ranging between three months and 16 years). The present­ing symptoms for which endoscopy was indicated were abdominal pain, heart burn and vomiting. Physical examination revealed upper abdominal tenderness in 79 (47.6%), pallor in 25 (15%), signs of malnutrition in 10 (6%) and hepatosplenomegaly in four (2.4%) patients. The endoscopic findings are illustrated in the [Table - 1].

Of the 115 patients in group A, endoscopy revealed gastritis in 30 (26%), duodenitis in 20 (17%), esophagitis in 13 (11%) and duodenal ulcer in seven (6%) patients. In the remaining 45 patients (40%) in this group, endoscopy was nor­mal. Gastric biopsies were obtained from 34 patients. The histologic diagnosis showed superfi­cial chronic active gastritis in 25 (73.5%) patients and it was normal in the remaining nine patients. Of the 25 patients with chronic gastritis, H. pylori was identified pathologically in 12 (48%)patients. An eight-year-old boy with abdominal pain, who showed normal endoscopic finding developed typ­ical purpuric rash and joint swelling diagnosed later as Henoch-Schonlein purpura.

Of the 21 patients in group B, the source of bleeding was identified in 10 (47.6%) patients. Erosive gastritis was the cause of bleeding in six (31.6%), duodenal ulcer in two (10.5%) patients and one each (5.3%) with gastroesophageal reflux disease and esophageal varices.

There were 13 patients in group C. The endos­copic findings in seven patients showed mild to moderate nonspecific inflammation in the duodenum and the upper part of the jejunum. The small bowel biopsy in these patients revealed celiac disease in three (21%), subtotal villous atrophy due to giardiasis in two (15.4%) and one each (7.7%) with intestinal lymphangiectasia and eosinophilic gastroenteritis. In the six patients with normal endoscopic findings (46%), cystic fib­rosis was diagnosed in two; intestinal duplication, abetalipoproteinemia, ulcerative colitis and Addi­son's disease in one each. Patients with accidental ingestion of FB (Group D) had routinely-plain abdominal x-ray prior to endoscopic procedure to confirm the presence of the FB and to identify its approximate location. The FB were successfully removed in all of them. These FB consisted of coins (25 halala) in six, hair clips in two and a fish bone was removed from the lower part of the esophagus in one.

Of the eight patients in group E, four with hepatosplenomegaly were subjected to UGI endoscopy to confirm esophageal varices sus­pected on barium meal study. Esophageal varices due to schistosomiasis were present in two patients. The hepatosplenomegaly in the remain­ing two patients was related to hematologic dis­ease, namely sickle cell disease. In the remaining two patients, the endoscopy of the first one showed circumferential necrosis and moderate to severe stenosis of the middle and lower part of the esophagus caused by accidental ingestion of a caustic substance. This patient required repeated endoscopic dilatation. Tuberculous esophagitis, which was suspected in the second patient, was confirmed histologically (granulomatous esophagitis). This patient was treated, and responded to antituberculous drugs. The UGI endoscopy in two patients with colonic polyposis was free of any abnormality.

The laboratory tests showed moderate hypo­chromicmicrocytic anemia in 39(23.5%) patients, which was caused mainly by UGI-bleeding, iron deficiency and sickle cell disease. In 16(9.6%) patients, the occult blood test was positive. Stool analysis showed giardia intestinalis infestation in four (2.4%) patients. The other tests were gener­ally within normal limits. No complications related to endoscopy were encountered in any patient.

   Discussions Top

Pediatric UGI endoscopy is proven to be a pre­ferred diagnostic and therapeutic tool in various gastrointestinal disorders. The concerns about its safety and efficacy have been alleviated by the introduction of special pediatric endoscopes that facilitate excellent visualization and better tolera­bility by children. The procedure is generally car­ried out under basal sedation in most cases [9],[10] . Some authors, however, recommend general anesthesia in young children [2],[6],[11] .

The indications in the majority of our patients were abdominal pain, heart burn and vomiting which were comparable with other reports [5],[11] . Endoscopic diagnoses of esophagitis, esophageal varices, gastritis, duodenitis and peptic ulcer dis­ease were made according to the accepted stan­dard criteria [12] . Gastritis was by far the most common endoscopic and histologic diagnosis fol­lowed by duodenitis and esophagitis. The fre­quency of gastritis in our patients is higher than that reported from the central region of Saudi Arabia [13] . Of interest was the identification of H. pylori in a relatively high percentage (48%) of patients with chronic gastritis. This is in agree­ment with other reports that the acquisition of H. pylori occurs in about 10% of children per annum between the ages of two and eight years [14].

Duodenal ulcer, which was seen in 4% of our patients, is similar to other reports [6],[13] . How­ever, Hagrove reported a figure of 8% in his series [15] . Gastric ulcer was not seen in our study. This is in contrast to the 5% reported by Al-Mofleh et al [13] . A low incidence of gastric ulcer has also been reported in adults from this institution where the ratio of duodenal to gastric ulcer was 7.6:1 [16] . The source of bleeding was identified in about half of the patients with hematemesis and the commonest cause was erosive gastritis. This is in contrast to other reports where peptic ulcer dis­ease is the common cause of bleeding [5],[13],[15] . The delay of presentation in some patients with hematemesis may explain the low diagnostic yield in this group. In our patients with chronic diarrhea and malabsorption syndrome, UGI endoscopy was very helpful in obtaining adequate small bowel biopsy material for the diagnosis of small bowel disorders, such as celiac disease and intesti­nal lymphangiectasia. The removal of foreign body through UGI endoscopy is safe; avoids radi­ation exposure and reduces hospital admission [9],[17] .

In conclusion, the common endoscopic abnor­malities observed in this study were gastritis associated with H. pylori infection, followed by duodenitis and esophagitis. We confirm previous findings that UGI endoscopy in infants and chil­dren is a safe and acceptable diagnostic, as well as therapeutic procedure.

   References Top

1.Gleason WA. Tedesco FJ, Keating JP, et al. Fiberoptic gastrointestinal endoscopy in infants and children. J Pediatrics 1974:85:810-3.  Back to cited text no. 1    
2.Cremer M, Peeters JP. Emonts P, et al. Fiberendoscopy of the gastrointestinal tract in children: experience with newly- designed fiberscopes. Endoscopy 6:1974:186-9.  Back to cited text no. 2    
3.Gans S, Ament ME, Christie DL, et al. Pediatric endos­copy with flexible fiberscopes. J Pediatr Surg 1975;10:375-80.  Back to cited text no. 3    
4.Ament ME, Gans SL, Christie DL. Experience with esophagogastroduodenoscopy in diagnosis of 79 pediat­ric patients with hematemesis, melena or chronic abdominal pain (Abstr). Gastroenterology 1975:68:858.  Back to cited text no. 4    
5.Tedesco FJ, Goldstein PD, Gleason WA. Keating JP. Upper gastrointestinal endoscopy in the pediatric patient. Gastroentrology I976;70(4):492-4.  Back to cited text no. 5    
6.Ament ME, Christie DL. Upper gastroentestinal fiberoptic endoscopy in pediatric patients. Gastroen­terology 1977:72(6):1244-8.  Back to cited text no. 6    
7.Cadranel S, Rodesch P, Peeters JP, Cremer M. Fiberen­doscopy of the gastrointestinal tract in children. Am J Dis Child 1977:131:41-5.  Back to cited text no. 7    
8.Cotton PB. Fiberendoscopy and the barium meal - results and implication. Br Med J 1973;2:161-5.  Back to cited text no. 8  [PUBMED]  [FULLTEXT]
9.Graham DY, Klish WJ, Ferry GD, et al. Value of fiberoptic gastrointestinal endoscopy in infants and chil­dren. South Med J 1978;71:558-60.  Back to cited text no. 9  [PUBMED]  
10.Chang MH, Wang TH, Hsu JY, et al. Endoscopic exmi­nation of the upper gastrointestinal tract in infancy. Gas­trointest Endosc 1983;29:15-7.  Back to cited text no. 10    
11.Gryboski JD. The value of upper gastrointestinal endos­copy in children. Dig Dis Sci 1981;26:17s-21s.  Back to cited text no. 11  [PUBMED]  
12.Kasugai T. Endoscopic diagnosis in Gastroenterology. Tokyo: Igaku: Shoin 1982.  Back to cited text no. 12    
13.Al-Mofleh IA, Jessen K, Al-Hmaid RS, Al-Samarrai AY, Al-Aska Al, Jawad AJ, AI-Faleh FZ. Pediatric esophagogastroduodenoscopy in Saudi Arabia. Ann Saudi Medi 1989;9:32-5.  Back to cited text no. 13    
14.Graham DY, Adam E, Reddy GT, et al. Seroepidemiol­ogy of Helicobacter pylon infection in India. Compari­son of developing and developed countries. Dig Dis Sci 1991;36:1084-8.  Back to cited text no. 14    
15.Hagrove CB, Ulshen MH, Shub MD. Upper gastrointes­tinal endoscopy in infants. Diagnostic usefulness and safety: Pediatrics 1984;74(5):828-31.  Back to cited text no. 15    
16.Al Quorain A, Satti MB, Al Hamdan A, Al-Ghassab G, Al-Freihi H, Al-Gindan Y. Pattern of upper gastrointes­tinal disease in the Eastern Province of Saudi Arabia. Trop and Geographic Med.1991;43(1,2);203-8.  Back to cited text no. 16    
17.Okasora T, Tomimoto Y, Okamoto E, et al. Endoscopic extraction of foreign bodies from the duodenum: four cases in infancy.Z Kinderchir 1984;39(2):147-8.  Back to cited text no. 17    

Correspondence Address:
A Lardhi
Department of Pediatrics, King Fahd Hospital of the University, P.O. Box 40051. Alkhobar 31952
Saudi Arabia
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Source of Support: None, Conflict of Interest: None

PMID: 19864837

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