ABSTRACT
BACKGROUND: Dyspepsia is poorly characterized in the pediatric population. The goal of the current study was to describe the clinical constellation and natural history of dyspepsia in children and adolescents seen in a pediatric gastroenterology practice. METHODS: A standardized questionnaire was administered by a pediatric gastroenterologist to all subjects 5 or more years of age (and their parents or guardians) treated in a referral pediatric gastroenterology practice for 1 month or more of abdominal pain or discomfort, nausea, or vomiting. Subjects with dyspepsia and dyspepsia subtypes (ulcer-like, dysmotility-like) were identified by using previously defined adult criteria. Evaluation and treatment were performed at the discretion of the attending pediatric gastroenterologist. RESULTS: During a 1-year period, 257 patients were screened with 127 subjects fulfilling criteria for dyspepsia (59% girls, 85% white; median age, 11.7 years; median duration of symptoms, 8 months). Symptoms were ulcer-like in 26% and dysmotility-like (nausea predominance) in 15% of subjects. In those with dyspepsia, irritable bowel syndrome and gastroesophageal reflux were noted in 24% and 43%, respectively. Esophagogastroduodenoscopy and biopsy were performed in 56 subjects with 21 (38%) having mucosal inflammation (Helicobacter pylori in 5). The remaining 35 subjects (62%) were considered to have functional dyspepsia. Duration of symptoms less than 1 year and vomiting were risk factors for mucosal inflammation. Follow-up at 6 months to 2 years revealed 70% of subjects were either asymptomatic or much improved regardless of the cause of dyspepsia. CONCLUSION: Most children and adolescents with dyspepsia do not have serious disease. In our referral population H. pylori infection was unusual, and no peptic ulceration was found. Most subjects with functional dyspepsia have improvement of symptoms over time.
Subject(s)
Dyspepsia/epidemiology , Dyspepsia/etiology , Adolescent , Adult , Child , Child, Preschool , Connecticut/epidemiology , Dyspepsia/pathology , Endoscopy, Digestive System , Female , Follow-Up Studies , Gastric Mucosa/pathology , Humans , Male , Prospective Studies , Surveys and QuestionnairesABSTRACT
Gastroesophageal reflux (GER) is a common problem confronting physicians involved in the care of children and adults. With the association of GER with asthma and chronic cough, physicians specializing in allergy/immunology require information on the pathogenesis, diagnosis, and management of GER. Eosinophilic esophagitis or eosinophilic gastroenteritis are poorly understood entities that may also lead to symptoms mimicking GER and are associated in many cases with underlying hypersensitivity of unknown immunologic mechanism.
Subject(s)
Asthma/diagnosis , Gastroenteritis/diagnosis , Gastroesophageal Reflux/diagnosis , Gastroesophageal Reflux/therapy , Adult , Asthma/physiopathology , Child , Child, Preschool , Diagnosis, Differential , Female , Gastroenteritis/physiopathology , Gastroesophageal Reflux/physiopathology , Humans , Infant , Male , PrognosisABSTRACT
We investigated the expression of gamma-aminobutyric acid type A (GABAA) receptor alpha 1-, alpha 2- and alpha 3-subunit mRNAs in the rat intestine using reverse transcription and polymerase chain reaction. alpha 1- and alpha 3-, but not alpha 2-, subunit mRNAs were amplified from the proximal intestine, ileum, and colon. In-situ hybridization studies demonstrated the expression of alpha 1-subunit mRNA by myenteric neurons. GABA may be active via the GABAA receptor in the enteric nervous system.
