Changing indications for upper endoscopy in children during a 20-year period

Abstract

Objectives: In parallel with the increase in pediatric esophagogastroduodenoscopy (EGD) procedures since the 1970s, the incidence of disorders that require EGD for diagnosis in children has increased. The aim of this study was to identify changes in subject characteristics and endoscopic procedures during a 20-year interval in children undergoing EGD at a single center.

Patients and methods: All of the children undergoing first EGD with biopsy in 1985, 1995, or 2005 were identified. Details of the clinical presentation and EGD were abstracted from medical records in a random sample of subjects within each time point.

Results: The number of first-time EGDs rose dramatically from 107 in 1985 to 1294 in 2005. The proportion of subjects that were younger than 1 year of age varied significantly from 13% in 1985 to 23% in 1995 and 8% in 2005 (P < 0.001). The proportion of subjects with gastrointestinal (GI) bleeding declined from 34% to 5% during the 20-year interval (P < 0.001), whereas the proportion with abdominal pain increased from 23% to 43% (P < 0.01). During the same interval, the proportion of subjects with complete EGD (biopsies from the esophagus, stomach, and duodenum) increased from 18% of EGDs in 1985 to 95% in 2005 (P < 0.001).

Conclusions: This study of children undergoing first-time EGDs with biopsy during a 20-year interval demonstrated significant differences in subject characteristics and endoscopy practices. The inclusion of children with less severe clinical presentation and the collection of greater numbers of biopsies per procedure may contribute to the rising incidence rates of pediatric GI disorders.

Figure 1. Total & First EGD in 1985, 1995 & 2005

Subjects who underwent EGD with biopsy at The Children's Hospital of Philadelphia during the calendar years 1985, 1995, and 2005.

Figure 2. Severity Index Among Incident EGD Subjects in 1985, 1995 & 2005

Among subjects undergoing incident EGD with biopsy, the indications for EGD were abstracted from medical records in a subsample and dichotomized into a severity index. Components indicative of high severity included: failure to thrive, gastrointestinal bleeding, severe systemic disease, abnormal UGI radiographic findings, and abnormal screening laboratory results.

Figure 3. Number of Esophageal Biopsies Among Incident EGD Subjects in 1985, 1995 & 2005

The number of esophageal biopsies obtained during incident EGDs in 1985, 1995, and 2005. This graphic representation of fewer esophageal biopsies obtained in 1985 compared to 1995 and 2005 supports the trends in declining proportions of esophageal histologic abnormalities in 1985, 1995, and 2005 depicted in Table 4. Subjects in 1985 were less likely to have screening esophageal biopsies obtained.