THE ROLE OF ENDOSCOPY IN DYSPEPTIC SYNDROME IN CHILDREN AND ADOLESCENTES

Dyspepsia is pain or discomfort in the epigastric region, and can be subdivided into organic and functional. The diagnosis of functional dyspepsia is based on the criteria defined by the Rome committee. In the pediatric population, functional dyspepsia is more common than organic dyspepsia, in addition to being part of a set of diseases called defined gastrointestinal disorders, defined by the Rome IV criteria. The most efficient diagnostic method of functional dyspepsia in the pediatric population is still uncertain since endoscopy is an important test to rule out organic changes, but it is invasive to be performed on a large scale.

Objective

To evaluate the role of endoscopy in the diagnosis of functional dyspepsia in pediatric patients, aiming at preventing invasive procedures and reaching high specificity in the result, which is important to determine the best diagnostic guideline for these patients.

Methods:

Narrative literature review study performed by searching for articles in the PubMed/Medline and LILACS database using the PRISMA method.

Results

A total of 102 articles were found in PubMed, 15 of which were selected for the study. In the LILACS database, nine articles were found and one was selected. Thus, 16 articles were selected for the study. The most appropriate indications for endoscopy, how to differentiate organic from functional dyspepsia without endoscopy, the main endoscopic findings of the studies, the differences between Rome III and Rome IV criteria, and the prevalence and factors possibly associated with functional dyspepsia were approached through the selected articles.

Conclusion

The main indication for endoscopy is the presence of alarm symptoms in pediatric patients with dyspepsia and the Rome clinical criteria are efficient for the diagnosis of functional dyspepsia. However, there is still no standardized diagnostic guideline to be followed in this age group.

Keywords:
Dyspepsia; children; diagnosis; endoscopy

Reference	Type of study	Sample number	Objective	Conclusion
Guariso G, et al. 2010.¹⁹19. Guariso G, Meneghel A, Pozza LVD, Romano C, Dall’Oglio L, Lombardi G, et al. Indications to Upper Gastrointestinal Endoscopy in Children With Dyspepsia. J Pediatr Gastroenterol Nutr . 2010;50:493-9.	Observational retrospective study	2304	Check if endoscopic indications for children with dyspepsia were adequate	Endoscopy is appropriately indicated only in cases of family history of peptic ulcer and/or H. pylori, when it interferes with daily activities, when age is more than 10 years, and the longer the duration and the more severe the symptoms.
Canan O, et al. 2011.²²22. Canan O, Ozcay F, Ozbay-Hosnut F, Yazici C, Bilezikci B. Value of the Likert Dyspepsia Scale in Differentiation of Functional and Organic Dyspepsia in Children. J Pediatr Gastroenterol Nutr . 2011;52:392-8.	Prospective experimental study	161 10-17 years	Define a symptomatic score that indicates organic dyspepsia, before endoscopy.	It was not possible to determine a cutoff value in the score that differentiated organic from functional dyspepsia.
Tam YH, et al. 2011.²⁰20. Tam YH, Chan KW, To KF, Cheung ST, Mou JWC, Pang KKY, et al. Impact of pediatric Rome III criteria of functional dyspepsia on the diagnostic yield of upper endoscopy and predictors for a positive endoscopic finding. J Pediatr Gastroenterol Nutr . 2011;52:387-91.	Prospective experimental study	80 7-15 years	To evaluate the efficiency of the Rome III criteria as a guideline to differentiate organic from functional dyspepsia, and identify predictors for positive endoscopic findings.	The Rome III criteria are effective in screening for functional dyspepsia in children and to differentiate from those with organic dyspepsia.
Carvalho MA, et al. 2012.²⁴24. Carvalho MA, Machado NC, Ortolan EVP, Rodrigues MAM. Upper Gastrointestinal Histopathological Findings in Children and Adolescents With Nonulcer Dyspepsia With Helicobacter pylori Infection. J Pediatr Gastroenterol Nutr . 2012;55:523-9.	Cross-sectional case control study	185 4-17 years	To investigate the histopathology of lesions in the gastric mucosa, associated with infection by H. pylori in patients with dyspepsia without peptic ulcer.	There is a higher prevalence of H. pylori infection in participants with dyspepsia who had significant inflammation in the mucosa.
Ganesh M, et al. 2014.²¹21. Ganesh M, Nurko S. Functional Dyspepsia in Children . Pediatric Annals. 2014;43:e101-5.	Review	-	To review the characteristics of functional dyspepsia, endoscopic findings, diagnostic method, types of treatment.	Functional dyspepsia must be diagnosed by the Rome III criteria.
Hyams JS, et al. 2016.⁵5. Hyams JS, Di Lorenzo C, Saps M, Shulman RJ, Staiano A, van Tilburg M. Childhood Functional Gastrointestinal Disorders: Child/Adolescent. Gastroenterology. 2016;150:1456-68.e2.	Review	-	To review the changes between Rome III and Rome IV criteria, regarding the definitions of disorders and their respective treatments.	The Roma IV committee does not believe that endoscopy is necessary to make a diagnosis of functional dyspepsia.
Koppen IJ, et al. 2017.¹⁸18. Koppen IJN, Nurko S, Saps M, Di Lorenzo C, Benninga MA. The pediatric Rome IV criteria: what’s new? Expert Rev Gastroenterol Hepatol . 2017;11:193-201.	Review	-	To report the news contained in the Rome IV criteria in comparison to the previous ones.	The Rome IV criteria are well formulated and help a lot in the diagnosis of functional gastrointestinal disorders in children.
Wauters L, et al. 2017.²⁶26. Wauters L, Nightingale S, Talley NJ, Sulaiman B, Walker MM. Functional dyspepsia is associated with duodenal eosinophilia in an Australian paediatric cohort. Aliment Pharmacol Ther. 2017;45:1358-64.	Cohort retrospective study	72 4-18 years	Association between dyspeptic symptoms and duodenal eosinophilia in endoscopy.	Functional dyspepsia is strongly related to duodenal eosinophilia.
Saps M, et al. 2019.²⁹29. Saps M, Moreno-Gomez JE, Ramírez-Hernández C, Rosen JM, Velasco-Benitez CA. A nationwide study on the prevalence of functional gastrointestinal disorders in school-children. Bol Med Hosp Infant Mex. 2017;74:407-12.	Cross-sectional	4394 8-18 years	To determine the prevalence of functional gastrointestinal disorders in school children in Colombia and its associated factors.	These disorders are more common in children in private schools than in public schools and are associated with stress.
Rajindrajith S, et a.l 2018.⁷7. Rajindrajith S, Zeevenhooven J, Devanarayana NM, Perera BJC, Benninga MA. Functional abdominal pain disorders in children. Expert Rev Gastroenterol Hepatol. 2018;12:369-90.	Review	-	Study on functional abdominal pain disorders.	Endoscopy should be considered when alarm symptoms are present.
Chumpitazi BP, et al. 2018.³⁰30. Chumpitazi BP, Robayo-Torres CC, Tsai CM, Opekun AR, Baker SS, Nichols BL, et al. Demographic and Clinical Correlates of Mucosal Disaccharidase Deficiencies in Children With Functional Dyspepsia. J Pediatr Gastroenterol Nutr . 2018;66:S52-5.	Retrospective and prospective	129 4-18 years	To determine the frequency, demographics and clinical characteristics associated with disaccharidase deficiency in children with dyspepsia.	Half of children with functional dyspepsia had disaccharidase deficiency. There may be a race/ethnicity relationship.
Friesen C, et al. 2018.³¹31. Friesen C, Singh M, Singh V, Schurman JV. An observational study of headaches in children and adolescents with functional abdominal pain. Medicine. 2018;97:e11395.	Cross-sectional retrospective	235 8-17 years	To evaluate the relationship between headaches and functional dyspepsia and headaches with mucosal mast cells and eosinophils.	Headaches are related to the presence of functional dyspepsia and to increased duodenal mast cell density and variety of somatic symptoms.
Saps M, et al. 2018.²⁸28. Saps M, Velasco-Benitez CA, Langshaw AH, Ramírez-Hernández CR. Prevalence of Functional Gastrointestinal Disorders in Children and Adolescents: Comparison Between Rome III and Rome IV Criteria. J Pediatr . 2018;199:212-6.	Observational	3767 8-18 years	Compare the prevalence of functional gastrointestinal disorders in children using the Rome III criteria and then, using the Rome IV criteria.	Using the Rome IV criteria resulted in a decrease in the prevalence of these disorders, and the new diagnoses of these criteria were present in a small percentage of children.
Trivić I, et al. 2018.²³23. Trivić I, Hojsak I. Initial Diagnosis of Functional Gastrointestinal Disorders in Children Increases a Chance for Resolution of Symptoms. J Pediatr Gastroenterol Nutr . 2018;21:264.	Observational	294 1-18 years	Detect the symptoms of patients with functional gastrointestinal disorders, the characteristics and results of the diagnostic investigation.	Early diagnosis increases the chance of symptom resolution, and these disorders affect quality of life.
Adeniyi OF, et al. 2019.²⁵25. Adeniyi OF, Odeghe EA, Lawal MA, Olowu AO, Ademuyiwa A. Recurrent abdominal pain and upper gastrointestinal endoscopy findings in children and adolescents presenting at the Lagos University Teaching Hospital. Tokuhara D, editor. Plos One. 2019;14:e0216394.	Prospective descriptive	113 Children under 19 years	Describe endoscopic findings in children with recurrent abdominal pain.	Upper gastrointestinal endoscopy is valuable in investigating recurrent abdominal pain in children, as it offers an accurate diagnosis of the causes.
Toporovski MS, et al. 1998.²⁷27. Toporovski MS, Neufeld CB, Chiara AMM, Françoso LA, Beznos GW, Coates V. Peptic disease: comparative study between children and adolescents. J Pediatr. 1998;74:233-8.		106 4-16 years	Compare clinical, endoscopic and colonization data of H. pylori in children and teenagers with peptic disease.	Prevalence of peptic disease in females. All with digestive bleeding associated with ulcerative lesions were colonized by H. pylori.

Instituto Brasileiro de Estudos e Pesquisas de Gastroenterologia e Outras Especialidades - IBEPEGE. Rua Dr. Seng, 320, 01331-020 São Paulo - SP Brasil, Tel./Fax: +55 11 3147-6227 - São Paulo - SP - Brazil
E-mail: secretariaarqgastr@hospitaligesp.com.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Corresponding author: Natália D’Amore Marciano. E-mail: natidamore@gmail.com