Evaluation of dyspepsia symptom severity in pediatric patients: association with endoscopic and pathological findings

Aims: There is diagnostic difficulty in distinguishing between organic and functional causes of dyspepsia, which is characterized by a variety of gastrointestinal symptoms. This study aimed to evaluate the correlation between dyspeptic complaints, clinical symptoms, endoscopic findings, and pathology results in pediatric patients. Methods: A total of 159 children aged 8-17 years with dyspeptic complaints underwent upper gastrointestinal endoscopy (UGE). The Dyspepsia Symptom Severity Index (DSSI), comprising three parts (dysmotility-like, reflux-like, and ulcer-like symptoms) and 19 questions, was used to assess symptom severity. Endoscopic procedures were performed under general anesthesia, and biopsy samples were obtained. Results: The study included 159 patients with a median age of 15 years (ranging from 8 to 17 years). Among them, 29.1% were male (38) and 76.9% were female (121). DSSI scores were calculated for each subgroup and the total score. When assessing the relationship between chronic diseases and DSSI scores, no significant association was found (p=0.48). However, smoking showed a significant correlation with DSSI scores (p=0.01 for dysmotility-like, p=0.02 for reflux-like, and p<0.01 for ulcer-like symptoms). Gender differences were observed in DSSI scores, with girls exhibiting significantly higher median scores for dysmotility-like findings compared to boys (p=0.02). Endoscopy findings also correlated with DSSI scores, with significantly higher scores in patients with ulcers (p<0.01). Pathological findings such as esophagitis were found to have significant associations with reflux-like symptoms (p=0.04), and crypt hyperplasia was associated with ulcer-like symptoms (p=0.04) in patients with DSSI subgroup scores. However, no significant differences were found between pathology findings and dyspepsia severity, significant associations were observed between UGE findings (such as ulcers, pangastritis, erosional areas, and fragility) and ulcer-like symptoms. Conclusion: The study found significant links between dyspepsia severity and endoscopic results, stressing the need for reliable symptom scales for pediatric patients. It also highlights smoking as a factor in dyspepsia severity in children. Further research is needed to evaluate endoscopy's effectiveness in distinguishing between organic and functional dyspepsia. The study points out the limited understanding and consensus on diagnosing and managing dyspepsia in children, calling for the development of validated symptom scales and further research into cost-effective management strategies.