Gastroenterology

Gastroenterology

Volume 142, Issue 4, April 2012, Pages 754-761
Gastroenterology

Original Research
Clinical—Alimentary Tract
Pediatric Patients With Dyspepsia Have Chronic Symptoms, Anxiety, and Lower Quality of Life as Adolescents and Adults

https://doi.org/10.1053/j.gastro.2011.12.043Get rights and content

Background & Aims

Little is known about long-term health outcomes of children with dyspeptic symptoms. We studied the natural history of pediatric patients with dyspeptic symptoms, with and without histologic reflux, compared with healthy controls.

Methods

We performed a prospective study of consecutive new patients, ages 8–16 years, who underwent evaluation for dyspepsia, including upper endoscopy. Patients were assigned to groups with histologic evidence of reflux esophagitis (n = 50), or normal histology results (n = 53). Healthy children were followed up as controls (n = 143). Patients and controls were evaluated 5–15 years later. They provided self-reports on severity of dyspeptic symptoms, use of acid suppression, quality of life, anxiety, and depression.

Results

When the study began, the groups with histologic evidence of esophagitis and normal histologies did not differ in severity of dyspeptic symptoms, functional disability, or depression. After a mean 7.6-year follow-up period, each group had significantly lower quality-of-life scores and more severe dyspeptic symptoms and functional disability than controls, but did not differ significantly from each other; both groups were significantly more likely than controls to meet criteria for an anxiety disorder. At time of follow-up evaluation, use of acid-suppression medication was significantly greater in the group with histologic evidence for esophagitis, compared with patients who had normal histology findings when the study began.

Conclusions

Among pediatric patients with dyspepsia evaluated by endoscopy and biopsy, those with histologic evidence for esophagitis or normal histology findings are at increased risk for chronic dyspeptic symptoms, anxiety disorder, and reduced quality of life in adolescence and young adulthood.

Section snippets

Sample

The study entailed a secondary analysis of an existing database of pediatric patients and community controls. The patient sample was drawn from several studies conducted by Walker et al32, 33, 34 between 1993 and 2004. Consecutive new patients referred to Vanderbilt Pediatric Gastroenterology Clinic for evaluation of abdominal pain were eligible for those studies if they were between the ages of 8 and 16 years, had abdominal pain of at least 3 months' duration, no chronic illness or disability,

Results

Figure 1 describes patient recruitment and the study timeline. Seven patients who underwent upper endoscopy but experienced fewer than 2 dyspeptic symptoms were excluded. Based on a review of medical records, 4 patients with Crohn's disease and 1 patient with cholelithiasis also were excluded. Thus, the final sample consisted of 183 pediatric patients with 2 or more dyspeptic symptoms who underwent endoscopy with biopsies. Of those whose upper endoscopy showed histologic reflux esophagitis, 50

Conclusions

This prospective cohort study of pediatric patients evaluated with upper endoscopy makes two important contributions to the literature. First, we found that these pediatric patients with dyspeptic symptoms, both with and without abnormal esophageal histology, had more dyspeptic symptoms, greater functional disability, and poorer health-related quality of life compared with controls in adolescence and young adulthood. Related studies have reported poorer health-related quality of life in

References (57)

  • J.P. Waring et al.

    Childhood gastroesophageal reflux symptoms in adult patients

    J Pediatr Gastroenterol Nutr

    (2002)
  • R.J. Young et al.

    A retrospective, case-control pilot study of the natural history of pediatric gastroesophageal reflux

    Dig Dis Sci

    (2007)
  • B.D. Gold

    Editorial: is gastroesophageal reflux disease really a life-long disease: do babies who regurgitate grow up to be adults with GERD complications?

    Am J Gastroenterol

    (2006)
  • S.R. Orenstein et al.

    Natural history of infant reflux esophagitis: symptoms and morphometric histology during one year without pharmacotherapy

    Am J Gastroenterol

    (2006)
  • B. Hegar et al.

    Natural evolution of regurgitation in healthy infants

    Acta Paediatr

    (2009)
  • A. Campanozzi et al.

    Prevalence and natural history of gastroesophageal reflux: pediatric prospective survey

    Pediatrics

    (2009)
  • S.P. Nelson et al.

    One-year follow-up of symptoms of gastroesophageal reflux during infancyPediatric Practice Research Group

    Pediatrics

    (1998)
  • M. Ashorn et al.

    The natural course of gastroesophageal reflux disease in children

    Scand J Gastroenterol

    (2002)
  • W.R. Treem et al.

    Gastroesophageal reflux in the older child: presentation, response to treatment and long-term follow-up

    Clin Pediatr

    (1991)
  • N. Tolaymat et al.

    Gastroesophageal reflux disease in children older than two years of age

    W V Med J

    (1998)
  • A.J. Martin et al.

    Natural history and familial relationships of infant spilling to 9 years of age

    Pediatrics

    (2002)
  • J.S. Hyams et al.

    Dyspepsia in children and adolescents: a prospective study

    J Pediatr Gastroenterol Nutr

    (2000)
  • A. Johnson et al.

    Safety of proton pump inhibitors

    J Gastroenterol Hepatol

    (2011)
  • R.B. Colletti et al.

    Overview of pediatric gastroesophageal reflux disease and proton pump inhibitor therapy

    J Pediatr Gasteroenterol Nutr

    (2003)
  • N. Vakil et al.

    The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus

    Am J Gastroenterol

    (2006)
  • P.M. Sherman et al.

    A global, evidence-based consensus on the definition of gastroesophageal reflux disease in the pediatric population

    Am J Gastroenterol

    (2009)
  • A. Fraser et al.

    Symptom-based outcome measures for dyspepsia and GERD trials: a systematic review

    Am J Gastroenterol

    (2005)
  • P. Aro et al.

    Functional dyspepsia impairs quality of life in the adult population

    Aliment Pharmacol Ther

    (2011)
  • Cited by (27)

    • Self-Perceived Food Intolerances Are Common and Associated with Clinical Severity in Childhood Irritable Bowel Syndrome

      2016, Journal of the Academy of Nutrition and Dietetics
      Citation Excerpt :

      It has been successfully used and validated in children with functional GI disorders.24,25 The total scores range from 0 to 60 with higher scores reflecting higher levels of perceived disability.24,26 The Pediatric Health-Related Quality of Life 4.0 Generic Core Scales is a 23-item, extensively validated questionnaire assessing health-related quality of life in healthy children and in those with medical conditions (including IBS).27,28

    • High Prevalence of Nausea among School Children in Latin America

      2016, Journal of Pediatrics
      Citation Excerpt :

      The burden of functional disorders, specifically functional nausea, is undervalued and incompletely studied. Although many studies show impaired quality of life, including school functioning in children with FGIDs,27,29-32 there are very few studies reporting on the psychosocial impact of chronic nausea. A recent study in North American children reported that the presence of nausea in children with abdominal pain-predominant FGIDs is linked to worse school functioning and social disability.1

    View all citing articles on Scopus

    Conflicts of interest The authors disclose no conflicts.

    Funding Supported by grants R01 HD23264 (Walker), T32DK007673 (Rippel), DK058404 (Vanderbilt Digestive Disease Research Center), UL1 RR024975 (Vanderbilt CTSA, National Center for Research Resources), P30 HD15052 (Vanderbilt Kennedy Center).

    View full text