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Kahrilas P, Anastasiou F, Bredenoord AJ, El Serag HB, Labenz J, Mendive J, Savarino EV, Sifrim D, Udrescu M, Yadlapati R, Hungin AP. Proton pump inhibitors: rational use and use-reduction. The Windsor Workshop. Dig Dis 2024:000538399. [PMID: 38513623 DOI: 10.1159/000538399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 03/13/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Despite deprescribing initiatives to curb overutilisation of proton pump inhibitors (PPIs), achieving meaningful reductions in PPI use is proving a challenge. SUMMARY An international group of primary care doctors and gastroenterologists examined the literature surrounding PPI use and use-reduction to clarify: (i) what constitutes rational PPI prescribing; (ii) when and in whom PPI use-reduction should be attempted; and (iii) what strategies to use when attempting PPI use-reduction. KEY MESSAGES • Before starting a PPI for reflux-like symptoms, patients should be educated on potential causes and alternative approaches including dietary and lifestyle modification, weight loss, and relaxation strategies. • When commencing a PPI, patients should understand the reason for treatment, planned duration and review date. • PPI use at hospital discharge should not be continued without a recognised indication for long-term treatment. • Long-term PPI therapy should be reviewed at least annually. • PPI use-reduction should be based on the lack of a rational indication for long-term PPI use, not concern for PPI-associated adverse events. • PPI use-reduction strategies involving switching to on-demand PPI or dose tapering, with rescue therapy for rebound symptoms, are more likely to succeed than abrupt cessation.
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Krill JT, Szafron D, Elhanafi S, Hussein MS, Patel K, Raijman I, Fisher W, El Serag HB, Othman MO. Endoscopic Ultrasound Finding of Diffuse Echogenicity in the Pancreas, Is It Relevant? Dig Dis Sci 2022; 67:3244-3251. [PMID: 34350519 DOI: 10.1007/s10620-021-07181-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 07/16/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND/OBJECTIVES Diffuse echogenicity of the pancreas, a commonly discovered finding on endoscopic ultrasound (EUS), is often of undetermined significance. The goal of this study was to characterize the clinical picture and pancreatic function in patients who incidentally present with this endosonographic finding. METHODS This was a case-control study comparing consecutive adult patients with diffuse echogenicity of the pancreas found on EUS to those who did not have known pancreas disease. Demographic and clinical data were extracted from the electronic medical record. The primary endpoint was exocrine pancreatic insufficiency (EPI) defined as fecal elastase (FE-1) < 200 μg/g. RESULTS A total of 166 patients were included in this study. There were 89 patients who had diffuse echogenicity of the pancreas on EUS and FE-1 testing. There were 77 control patients with chronic diarrhea who did not have known pancreas disease but did have FE-1 testing. EPI was significantly more likely in the fatty pancreas group compared to the control group (47% vs 6%, p < 0.001). There was also a significantly greater proportion of smokers in the fatty pancreas group compared to the control group (42% vs 17%, p = 0.002). There were no other differences in baseline characteristics between the two groups, including prevalence of chronic pancreatitis by Rosemont classification. On multiple logistic regression analysis controlling for multiple variables, smoking (OR 2.26, 95% CI 1.15-4.43) and NAFLD (OR 3.99, 95% CI 1.09-14.70) had significant associations with EPI. CONCLUSIONS This study found a significantly greater amount of patients who had diffuse echogenicity of the pancreas on EUS to also have EPI. This is compared to a control group of patients without known pancreas disease. This prevalence was found in the absence of a significant association with chronic pancreatitis on EUS based on Rosemont classification. Future controlled studies are required to further investigate this relationship.
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Affiliation(s)
- Joseph T Krill
- Division of Gastroenterology, Baylor College of Medicine, Houston, TX, USA
| | - David Szafron
- Department of Internal Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Sherif Elhanafi
- Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, AZ, USA
| | - Mohammed S Hussein
- Division of Gastroenterology, Baylor College of Medicine, Houston, TX, USA.,Department of Internal Medicine, Al-Azhar University, Cairo, Egypt
| | - Kalpesh Patel
- Division of Gastroenterology, Baylor College of Medicine, Houston, TX, USA
| | | | - William Fisher
- Department of General Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Hashem B El Serag
- Division of Gastroenterology, Baylor College of Medicine, Houston, TX, USA
| | - Mohamed O Othman
- Division of Gastroenterology, Baylor College of Medicine, Houston, TX, USA. .,Chief of Gastroenterology Section, Baylor St Luke's Medical Center, 7200 Cambridge St. STE 10C, Houston, TX, 77030, USA.
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Gantuya B, Serag HBE, Saruuljavkhlan B, Azzaya D, Matsumoto T, Uchida T, Oyuntsetseg K, Oyunbileg N, Davaadorj D, Yamaoka Y. Advantage of 16S rRNA amplicon sequencing in Helicobacter pylori diagnosis. Helicobacter 2021; 26:e12790. [PMID: 33596345 PMCID: PMC8122063 DOI: 10.1111/hel.12790] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 01/26/2021] [Accepted: 01/26/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND 16S rRNA amplicon sequencing is an accurate method of detecting microbial infection without culture. It is unclear if sequencing has additional benefits over routine diagnostic methods for Helicobacter pylori testing. METHODS We enrolled Mongolian volunteers with dyspepsia. Using routine diagnostic methods, positive H. pylori was defined as positive results on histology/immunohistochemistry, culture, rapid urease test, or serology; negative H. pylori was defined by negative results from all these tests. We performed 16S rRNA sequencing on gastric biopsy specimens and calculated cutoffs for operational taxonomic units (OTUs) and relative abundance (RA) to define positive results using ROC curves. RESULTS We examined 161 individuals with a mean age of 43.6 years, and 64.6% were women. Using routine diagnostic methods, 122 (75.8%) participants were H. pylori positive, the sensitivity and specificity for 16S rRNA sequencing were 94.3% and 82.1% or 93.4% and 82.1% when cutoff values were set to 1113 (OTU number) or 4.4% RA, respectively (both p < .001). When combining the validated values, the concordance rate was high (91.1%); however, 16S rRNA sequencing had additional positive yield in 9 cases (5.6%) compared with routine diagnostic methods, and much greater additional positive yield compared to histopathology/IHC, culture, RUT, serology separately with 12 (7.4%), 37 (23.0%) and 43 (26.7%). CONCLUSION 16S rRNA amplicon sequencing detects potentially important proportion of H. pylori-positive cases that test negative with routine diagnostic methods. The quantitative number of H. pylori can help to understand how it can be changing by diseases and RA give opportunity to understand how H. pylori communicate with other microbiota.
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Affiliation(s)
- Boldbaatar Gantuya
- Department of Gastroenterology, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia,Endoscopy Unit, Mongolia—Japan teaching hospital, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Hashem B. El Serag
- Department of Medicine, Gastroenterology and Hepatology Section, Baylor College of Medicine, Houston, Texas 77030, USA
| | | | - Dashdorj Azzaya
- Department of Environmental and Preventive Medicine, Oita University of Medicine, Yufu, Japan
| | - Takashi Matsumoto
- Department of Environmental and Preventive Medicine, Oita University of Medicine, Yufu, Japan
| | - Tomohisa Uchida
- Department of Molecular Pathology, Oita University of Medicine, Yufu, Japan
| | - Khasag Oyuntsetseg
- Department of Gastroenterology, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia,Endoscopy Unit, Mongolia—Japan teaching hospital, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Nyamdorj Oyunbileg
- Department of Gastroenterology, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Duger Davaadorj
- Department of Gastroenterology, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia,Endoscopy Unit, Mongolia—Japan teaching hospital, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Yoshio Yamaoka
- Department of Medicine, Gastroenterology and Hepatology Section, Baylor College of Medicine, Houston, Texas 77030, USA,Department of Environmental and Preventive Medicine, Oita University of Medicine, Yufu, Japan
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Gantuya B, El Serag HB, Matsumoto T, Ajami NJ, Uchida T, Oyuntsetseg K, Bolor D, Yamaoka Y. Gastric mucosal microbiota in a Mongolian population with gastric cancer and precursor conditions. Aliment Pharmacol Ther 2020; 51:770-780. [PMID: 32133670 PMCID: PMC8761497 DOI: 10.1111/apt.15675] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 09/21/2019] [Accepted: 02/07/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Incidence and mortality of gastric cancer (GC) are high in Mongolia despite Helicobacter pylori in the Mongolian population being less virulent. AIM To evaluate gastric bacterial microbiota profiles in patients with GC and its precursor histological conditions. METHODS We conducted a case-control study among 48 GC and 120 noncancer patients (20 normal gastric mucosa [control], 20 gastritis, 40 with atrophy and 40 intestinal metaplasia [IM]). We performed 16S rRNA gene amplicon sequencing and compared taxonomic and functional prediction profiles based on the diagnosis group and H pylori infection status. RESULTS The highest overall bacterial alpha diversity metrics were observed in the control group, followed by the IM and cancer groups. The gastritis and atrophy groups had the least diversity. Lactobacilli and Enterococci were the dominant genus in several cancer patients especially in the absence of H pylori. In addition, Carnobacterium, Glutamicibacter, Paeniglutamicibacter, Fusobacterium and Parvimonas were associated with GC regardless of H pylori infection. Firmicutes were decreased in the gastritis and atrophy groups and increased in the IM and cancer groups. The functional metabolic activity of the Embden-Meyerhof-Parnas pathway and the utilization of sugar, were significantly increased in cancer group compared with the noncancer group. CONCLUSION Microbial factors other than H pylori may play a role in Mongolian GC. We identified novel associations between GC and the genera Enterococcus, Lactobacillus, Carnobacterium, Glutamicibacter, Paeniglutamicibacter, Fusobacterium, and Parvimonas.
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Affiliation(s)
- Boldbaatar Gantuya
- Department of Gastroenterology, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia.,Endoscopy Unit, Mongolia-Japan Teaching Hospital, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Hashem B El Serag
- Department of Medicine, Gastroenterology and Hepatology Section, Baylor College of Medicine, Houston, TX, USA
| | - Takashi Matsumoto
- Department of Environmental and Preventive Medicine, Oita University of Medicine, Yufu, Japan
| | - Nadim J Ajami
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA
| | - Tomohisa Uchida
- Department of Molecular Pathology, Oita University of Medicine, Yufu, Japan
| | - Khasag Oyuntsetseg
- Department of Gastroenterology, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia.,Endoscopy Unit, Mongolia-Japan Teaching Hospital, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Dashdorj Bolor
- Department of Endoscopy, Mongolian National Cancer Center Hospital, Ulaanbaatar, Mongolia
| | - Yoshio Yamaoka
- Department of Medicine, Gastroenterology and Hepatology Section, Baylor College of Medicine, Houston, TX, USA.,Department of Environmental and Preventive Medicine, Oita University of Medicine, Yufu, Japan
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Gupta S, Li D, El Serag HB, Davitkov P, Altayar O, Sultan S, Falck-Ytter Y, Mustafa RA. AGA Clinical Practice Guidelines on Management of Gastric Intestinal Metaplasia. Gastroenterology 2020; 158:693-702. [PMID: 31816298 PMCID: PMC7340330 DOI: 10.1053/j.gastro.2019.12.003] [Citation(s) in RCA: 140] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Samir Gupta
- Department of Veterans Affairs San Diego Healthcare System, San Diego, California;,Division of Gastroenterology and the Moores Cancer Center, University of California San Diego, La Jolla, California
| | - Dan Li
- Department of Gastroenterology, Kaiser Permanente Santa Clara Medical Center, Santa Clara, California;,Division of Research, Kaiser Permanente Northern California, Oakland, California
| | | | - Perica Davitkov
- Veterans Administration, Northeast Ohio Healthcare System, Cleveland, Ohio;,Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Osama Altayar
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri
| | - Shahnaz Sultan
- Minneapolis Veterans Affairs Healthcare System, University of Minnesota, Minneapolis, Minnesota
| | - Yngve Falck-Ytter
- Department of Veterans Affairs Cleveland Medical Center, Cleveland, Ohio;,Case Western Reserve University, Cleveland, Ohio
| | - Reem A. Mustafa
- Department of Internal Medicine, University of Kansas Medical Center, Kansas
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Petrick JL, Li N, Anderson LA, Bernstein L, Corley DA, El Serag HB, Hardikar S, Liao LM, Liu G, Murray LJ, Rubenstein JH, Schneider JL, Shaheen NJ, Thrift AP, van den Brandt PA, Vaughan TL, Whiteman DC, Wu AH, Zhao WK, Gammon MD, Cook MB. Diabetes in relation to Barrett's esophagus and adenocarcinomas of the esophagus: A pooled study from the International Barrett's and Esophageal Adenocarcinoma Consortium. Cancer 2019; 125:4210-4223. [PMID: 31490550 PMCID: PMC7001889 DOI: 10.1002/cncr.32444] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 05/22/2019] [Accepted: 07/09/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Diabetes is positively associated with various cancers, but its relationship with tumors of the esophagus/esophagogastric junction remains unclear. METHODS Data were harmonized across 13 studies in the International Barrett's and Esophageal Adenocarcinoma Consortium, comprising 2309 esophageal adenocarcinoma (EA) cases, 1938 esophagogastric junction adenocarcinoma (EGJA) cases, 1728 Barrett's esophagus (BE) cases, and 16,354 controls. Logistic regression was used to estimate study-specific odds ratios (ORs) and 95% CIs for self-reported diabetes in association with EA, EGJA, and BE. Adjusted ORs were then combined using random-effects meta-analysis. RESULTS Diabetes was associated with a 34% increased risk of EA (OR, 1.34; 95% CI, 1.00-1.80; I2 = 48.8% [where 0% indicates no heterogeneity, and larger values indicate increasing heterogeneity between studies]), 27% for EGJA (OR, 1.27; 95% CI, 1.05-1.55; I2 = 0.0%), and 30% for EA/EGJA combined (OR, 1.30; 95% CI, 1.06-1.58; I2 = 34.9%). Regurgitation symptoms modified the diabetes-EA/EGJA association (P for interaction = .04) with a 63% increased risk among participants with regurgitation (OR, 1.63; 95% CI, 1.19-2.22), but not among those without regurgitation (OR, 1.03; 95% CI, 0.74-1.43). No consistent association was found between diabetes and BE. CONCLUSIONS Diabetes was associated with increased EA and EGJA risk, which was confined to individuals with regurgitation symptoms. Lack of an association between diabetes and BE suggests that diabetes may influence progression of BE to cancer.
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Affiliation(s)
- Jessica L. Petrick
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Nan Li
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Lesley A. Anderson
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queens University Belfast, Northern Ireland
| | - Leslie Bernstein
- Division of Biomarkers of Early Detection and Prevention, Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Douglas A. Corley
- Division of Research, Kaiser Permanente, Northern California, Oakland, CA, USA
| | - Hashem B. El Serag
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Sheetal Hardikar
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Linda M. Liao
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Geoffrey Liu
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Liam J. Murray
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queens University Belfast, Northern Ireland
| | - Joel H. Rubenstein
- Ann Arbor Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI, USA
- Barrett’s Esophagus Program, Division of Gastroenterology, University of Michigan, Ann Arbor, MI, USA
| | | | - Nicholas J. Shaheen
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC, USA
| | - Aaron P. Thrift
- Section of Epidemiology and Population Sciences, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Piet A. van den Brandt
- Department of Epidemiology, GROW School for Oncology and Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Thomas L. Vaughan
- Program in Cancer Epidemiology, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - David C. Whiteman
- Cancer Control, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Anna H. Wu
- Department of Preventive Medicine, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Wei K. Zhao
- Division of Research, Kaiser Permanente, Northern California, Oakland, CA, USA
| | - Marilie D. Gammon
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - Michael B. Cook
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
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Thakkar K, Alsarraj A, Fong E, Holub JL, Gilger MA, El Serag HB. Prevalence of colorectal polyps in pediatric colonoscopy. Dig Dis Sci 2012; 57:1050-5. [PMID: 22147243 PMCID: PMC3878076 DOI: 10.1007/s10620-011-1972-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2011] [Accepted: 11/08/2011] [Indexed: 01/10/2023]
Abstract
BACKGROUND The available data regarding the prevalence, types, and clinical determinants of colonic polyps in children is limited. AIMS We aimed to estimate the prevalence of colorectal polyps in a large cohort of children. METHODS We conducted a cross-sectional study to determine the presence, number, and location of colorectal polyps reported in all children (0-20 years) who underwent colonoscopy at 14 pediatric facilities between January 2000 and December 2007 recorded in Pediatric Endoscopy Database System Clinical Outcomes Research Initiative (PEDS-CORI). We compared procedures with and without polyps with respect to procedure indication, age, sex, and race. We also reviewed a sample of histopathologic reports from one participating center. RESULTS We analyzed 13,115 colonoscopy procedures performed in 11,637 patients. Colorectal polyps were reported in 810 procedures (6.1%; 95% CI: 5.7-6.5%) performed in 705 patients, and in 12% of patients with lower GI bleeding. Children with colorectal polyps were significantly younger (8.9 years vs. 11.9 years; p < 0.0001), male (58.3% vs. 49.0%; p < 0.001), non-white race (27.5% vs. 21.9%; p < 0.001), and had lower GI bleeding (54.4% vs. 26.6%; p < 0.001) as compared to children without polyps. In a sample of 122 patients with polyps from a single center, the histological types were solitary juvenile in 91 (70.5%), multiple juvenile in 20 (15.5%), adenoma in 14 (10.9%) and hyperplastic polyps in four patients (3.1%). CONCLUSIONS Colorectal polyps are detected in 6.1% overall and in 12.0% among those with lower gastrointestinal bleeding during pediatric colonoscopy. Approximately 26% are multiple juvenile or adenoma.
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Affiliation(s)
- Kalpesh Thakkar
- The Section of Pediatric Gastroenterology, Hepatology and Nutrition at Texas Children’s Hospital and Baylor College of Medicine, Houston, TX
| | - Abeer Alsarraj
- The Sections of Gastroenterology and Health Services Research at The Houston Veterans Affairs Medical Center and the Department of Medicine at Baylor College of Medicine, Houston, TX
| | | | - Jennifer L. Holub
- Department of Gastroenterology, Oregon Health & Science University, Portland, OR
| | - Mark A. Gilger
- The Section of Pediatric Gastroenterology, Hepatology and Nutrition at Texas Children’s Hospital and Baylor College of Medicine, Houston, TX
| | - Hashem B. El Serag
- The Sections of Gastroenterology and Health Services Research at The Houston Veterans Affairs Medical Center and the Department of Medicine at Baylor College of Medicine, Houston, TX
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Abstract
BACKGROUND We performed a systematic review to examine the diagnostic yield (endoscopic and histologic) of esophagogastroduodenoscopy (EGD) for the evaluation of abdominal pain of unclear etiology in children. We also examined the effect of EGD on change in treatment, quality of life, change in abdominal pain, and cost-effectiveness. METHODS All full-length articles published in English during 1966-2005 were included if: (a) participants had abdominal pain without known underlying gastrointestinal disease, (b) participants underwent EGD primarily for the evaluation of abdominal pain, (c) findings of the EGD were reported, (d) participants were under 18 yr, and (e) sample size greater than 50. RESULTS Eighteen articles examining 1,871 patients fulfilled the inclusion and exclusion criteria. All were observational and most (13) were prospective. Only three studies were performed in the United States and of those two were prospective. The largest study examined about 400 procedures and 13 studies examined less than 100 procedures. One case of inflammatory bowel disease and 67 duodenal or gastric ulcers were reported, thus diagnostic yield was achieved in 3.6% of cases. The prevalence of nonspecific histological gastrointestinal inflammatory lesions varied between 23% and 93%. Six articles attempted to correlate endoscopic or histologic findings with treatment management decisions. No articles attempted to describe quality of life or cost-effectiveness. None of the studies analyzed the association of alarm symptoms or signs to diagnostic yield. CONCLUSIONS The diagnostic yield of EGD in children with unclear abdominal pain is low; however, existing studies are inadequate. The effect of EGD on change in treatment, quality of life, improvement of abdominal pain, and cost-effectiveness is unknown. The predictors of significant findings are unclear. Our findings suggest that a large multicenter study examining clinical factors, biopsy reports, and addressing patient outcomes is needed to further clarify the value of EGD in children with abdominal pain.
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Affiliation(s)
- Kalpesh Thakkar
- The Section of Pediatric Gastroenterology, Hepatology and Nutrition, Baylor College of Medicine, Houston, Texas, USA
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