Endoscopic and Histopathologic changes in Children with Chronic dyspepsia in a Rural Medical College Hospital in Melmaruvathur-Tamil Nadu

Chronic pain abdomen and dyspepsia is the most common presenting symptoms in the paediatric outpatient department (OPD) after respiratory illnesses. It is increasing alarmingly both in the paediatric and adult population. We, therefore carried out a cross sectional study among children aged between 5 to 15 years, attending Paediatric OPD with chronic dyspepsia in a rural medical college hospital, Melmaruvathur, Tamil Nadu, South India.

To evaluate the gastroduodenal morbidity in children presenting to the paediatric department of a rural medical college hospital with chronic dyspeptic symptoms.

Forty six children between the age group of 5 to 15 years with chronic dyspeptic symptoms of at least one month duration were evaluated for their symptom profile, epidemiological profile, nutritional status, endoscopic appearance and histopathological changes. Data analysis was done using SPSS version 18.

Of the 46 children studied, 43% were between the age group of 5–10 years and 70% were female children. Pain abdomen lasting for more than at least one month was the most common finding (93%) observed. Other common symptoms in the order of decreasing frequency were, early satiety (87%), Poor appetite (76%), Nausea (57%) and not thriving (57%). History of loss of appetite was significantly associated with chronic dyspepsia with an odds ratio of 68.9394 and 95% confidence interval 26.62 to 178.54, p value of <0.0001. Most of the children belonged to lower income group predominantly of a rural background. 33 (72%) children had under nutrition as per IAP (Indian Academy of Paediatrics) classification based on WHO growth charts. 10 (30%) Grade I, 15 (45%) Grade II and eight (24%) had Grade III malnutrition. 26 children (57%) had abnormal endoscopic findings. Antral mucosal biopsy done showed chronic lymphocytic gastritis in 44 (96%) cases. 38 of these 44 (86%) were H.pylori positive. H. pylori positivity in chronic dyspepsia was highly statistically significant with a p value of 0.0001.

The incidence of dyspepsia is common among children between the age group of 5–10 years with a female preponderance. The predominant symptoms noted among these rural children are abdominal pain and loss of appetite. We found that endoscopy has a very high pick up rate of macroscopic gastroduodenal pathology. Multiple gastric erosions is the most common finding observed endoscopically and H.pylori associated lymphocytic gastritis is the overwhelming finding in our children with chronic dyspepsia.