Primary Presenting Symptoms and Their Relationship With Endoscopic and Histopathological Findings in Pediatric Upper Gastrointestinal Endoscopy

Aim: This study aimed to evaluate the association between primary presenting gastrointestinal symptoms and endoscopic and histopathological findings in children undergoing upper gastrointestinal endoscopy (UGIE), and to identify independent predictors of histopathological abnormalities.Materials and Methods: In this retrospective study, 578 children aged 0–18 years who underwent UGIE at Ankara Etlik City Hospital between January 2023 and January 2025 were classified into four primary symptom groups: abdominal pain, gastroesophageal reflux (GER)/vomiting, upper gastrointestinal bleeding, and other nonspecific symptoms. Endoscopic and histopathological findings were compared across groups, and predictors of histopathological inflammation were determined using univariate and multivariate logistic regression analysis.Results: The median age was 12 years (interquartile range: 9–15), and 61.8% of patients were female. Abdominal pain was the most common presenting symptom (50%), followed by GER/vomiting (34.3%), upper gastrointestinal bleeding (8.5%), and other symptoms (7.3%). Duodenogastric reflux was more frequent in the GER/vomiting group, whereas nodular gastritis predominated in the abdominal pain group. Upper gastrointestinal bleeding was strongly associated with erosive gastritis (odds ratio [OR]: 6.59) and peptic ulcer disease (OR: 4.47). Helicobacter pylori-positive patients showed significantly higher rates of moderate-to-severe inflammation (65.9% vs. 25.0%; OR: 5.81), lower hemoglobin, iron, ferritin, and vitamin B12 levels, and a higher neutrophil-to-lymphocyte ratio (NLR), which correlated with histological activity (rho = 0.54).Conclusion: Primary presenting symptoms are partially associated with specific endoscopic phenotypes but cannot reliably substitute for histopathological confirmation. Helicobacter pylori infection contributes substantially to both local inflammatory severity and systemic hematological changes, and NLR may serve as a supportive, non-invasive marker of gastric inflammatory activity in children.