Esophagogastric diseases may be the major causes of chest pain in children thancardiac diseases

Abstract

Background and Aim: There are children who present with severe chest pain. Most pediatricians approach to diagnose any cardio-pulmonary disease in these children. The purpose of this study is to find out how many upper gastrointestinal diseases are the major causes of chest pain in pediatric patients.Methods: Seventy-five children (42 boys and 33 girls, aged 3–17 years old) have presented with mainly chest pain from January 1995 to March 2015. The records of these patients were reviewed. Chest X-ray and electrocardiography were performed in all patients. Further cardiologic evaluation included echocardiography, exercise stress test, and 24-h Holter monitoring. Gastrointestinal evaluations such as upper GI endoscopy, gastroesophageal scan, and 24-h ambulatory pH monitoring were performed on appropriate candidates.Results: Chest pain was most common in children of 6 years old and 9 to 14 years old. Esophago-gastric diseases were unexpectedly the most common direct causes of chest pain (48 cases; 64%); the next are idiopathic (16%), cardiac diseases (12%), chest trauma (4%), respiratory disease (3%), and psychosomatic disease (1.3%) Even though 21 children showed abnormal ECG findings and seven showed abnormalities on echocardiography, cardiac diseases were determined to be the direct causes only in nine. UGI endoscopy was performed in 57 cases; esophago-gastric diseases, which thereafter were thought to be causative diseases, were in 48 cases. The mean age of the children with esophago-gastric diseases was different with marginal significance from that of the other children with chest pain not related with esophago-gastric diseases. All the 48 children were diagnosed, treated with GI medicines based on the diagnosis; 37 cases (77%) subsequently showed clinical improvement.Conclusion: Differential diagnostic approaches to find out UGI diseases in the children with chest pain are clinically important as well as cardiac and respiratory investigations.