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BACKGROUND

Children often experience epigastric discomfort or dyspepsia either as a presenting symptom or during hospitalization. The challenge to the hospitalist is to identify the cause or causes based on typically vague complaints, a wide differential, generally indirect examination of the affected area, and laboratory and radiographic evaluations that are nonspecific and rarely diagnostic.

CLINICAL PRESENTATION

Nausea, vomiting, heartburn, regurgitation, early satiety, postprandial abdominal bloating or distention, excess gas with or without belching or flatulence, queasiness, fullness, and retching are all common presentations of gastric dysfunction. These symptoms overlap with the discussions of other disorders such as abdominal pain, gastrointestinal (GI) bleeding, failure to thrive, and feeding issues.

Dyspepsia is defined as chronic or recurrent pain or discomfort in the upper abdomen (above the umbilicus), with discomfort being a subjective sensation that may include fullness and early satiety.1-3 These symptoms are typically to the exclusion of “heartburn” or a burning sensation in the retrosternal region, which is generally presumed to be gastroesophageal reflux disease (GERD).3 In one study of children at a tertiary center evaluated for unexplained recurrent abdominal pain, 15.9% met criteria for functional dyspepsia, a term applied to dyspeptic symptoms absent other identifiable disease.4

The timing of symptoms is often helpful in determining the presence of underlying disease. Pain attributable to gastric ulceration often peaks when the stomach is empty, whereas pain associated with functional dyspepsia usually develops immediately after eating and may linger for hours.

DIFFERENTIAL DIAGNOSIS

Many disorders can cause dyspepsia, including functional, mucosal, and anatomic abnormalities of the stomach or extragastric GI system. In addition, extra-GI disorders, such as genitourinary or psychiatric dysfunction, can have prominent dyspeptic symptoms (Table 77-1).

TABLE 77-1Differential Diagnosis for Dyspepsia

DIAGNOSIS AND EVALUATION

The broad differential diagnosis and the subjective nature of these symptoms can present a challenge, and a standard approach or algorithm for evaluation is difficult to establish. Certainly a timeline as well as any type of symptom journal that the patient or family can provide is helpful. Initial questions should include duration of symptoms, antecedent infection ...

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