Sex, Psychosocial Factors, and Reported Symptoms Influence Referral for Esophagogastroduodenoscopy and Biopsy Results in Children with Chronic Abdominal Pain

Objectives: To identify symptoms and psychosocial factors that predicted referral for esophagogastroduodenoscopy (EGD) and discriminated between patients with positive versus negative biopsy findings.

Patients And Methods: Children age 8 to 16 years old and parents completed validated questionnaires assessing gastrointestinal symptoms and psychosocial characteristics. Biopsy results of esophagus, stomach, and duodenum were reviewed.

Results: From the total sample of 461 patients (mean age 11.87 years, 62% girls), 127 (28%) underwent EGD with biopsy (mean age 12.1 years, 57% girls). Upper abdominal gastrointestinal symptoms predicted EGD referral, and psychosocial characteristics did not. From the total of 127 patients who underwent EGD, complete biopsy results were available for 124 patients and were negative at all sites for 34.7% of patients (n = 43), equivocal for 20.2% (n = 25), and positive at 1 or more sites for 45.2% (n = 56). Boys were more likely than girls to have positive biopsy results (56.6% vs 36.6%, P < 0.03) because of the higher rate of positive esophageal biopsy results (47.2% vs 26.8%, P < 0.04). Among boys, vomiting (P < 0.02) and family stress (P < 0.04) predicted positive esophageal biopsy findings. Among girls, depressive symptoms predicted positive biopsy findings (P = 0.015).

Conclusions: Upper abdominal symptoms, sex, stress, and depressive symptoms predict positive EGD biopsy findings in patients with chronic abdominal pain. Research on mechanisms linking these factors to mucosal damage in the gut is warranted.