Appropriateness of upper gastrointestinal endoscopy in children: a retrospective study.

BACKGROUND: Upper gastrointestinal endoscopy (UGIE) is appropriate in many situations in adults and children. Recommendations for UGIE use in children were published recently by the French-language Paediatric Hepatology, Gastroenterology, and Nutrition Group (GFHGNP). PATIENTS AND METHODS: We retrospectively reviewed the 293 UGIE procedures undertaken in 251 children between January 1, 2001 and June 30, 2003 by 2 senior endoscopists. The UGIE procedures were categorized as appropriate or inappropriate based on GFHGNP recommendations, and diagnostic efficiency was compared in the 2 groups with the chi2 test followed by multivariate logistic regression analysis. RESULTS: Of the 293 UGIE procedures, 52 (17.7%) were considered inappropriate. Diagnostic efficiency was 51% in the appropriate group versus 17.3% in the inappropriate group (odds ratio, 4.2; 95% CI, 2-8.7; P < 10(-3)). The proportion of appropriate UGIE procedures was higher among inpatients than outpatients (odds ratio, 2.51; 95% CI, 1.24-5.08; P = 0.01). Inappropriate reasons for performing UGIE included isolated failure to thrive and follow-up after neonatal esophagogastroduodenitis. Nine inappropriate UGIE procedures contributed useful information: ulcerative esophagitis in 1 patient, hemorrhagic esophagitis in 4 patients, duodenitis in 1 patient, and malabsorption in 3 patients caused in 1 case by cow's milk allergy and in 2 cases to fully documented celiac disease. CONCLUSIONS: UGIE was usually performed appropriately in our pediatric hospital. Inappropriate UGIE procedures were more common in outpatients than in admitted patients. Awareness of the recommendations for appropriate UGIE use needs to be improved among office-based and hospital-based physicians.

Analysis of the olfactory capacity of healthy children before language acquisition.

The absence of a method for evaluating the olfaction of infants and children without structured language led us to perform a longitudinal study of the behavioral responses of very young children. The aim was to establish a tool for verifying a child's olfactory ability during a pediatric examination. A total of 107 subjects were observed and filmed during a regular olfactory activity. Three years of filmed observations were analyzed and showed three types of stable behavioral responses that we consider to be specific to olfactory stimulus: modification of respiratory rhythm, fixed stare, and decrease of mobility. These responses were observed for 98% of the subjects in 100% of the first presentations of the odorized tissue. Response time was not influenced by age, socioeconomic situation, or position in the family, but it was influenced by ethnic background. These responses constitute items allowing the first step of an objective assessment of a prelanguage child's olfaction without the subject's verbal participation.