Pediatric gastric and duodenal disorders

Purpose of review: This review provides a summary of new developments regarding common diseases affecting the stomach and duodenum in children. Recent findings: Celiac disease seems to be more prevalent than previously thought in different areas of the world, including the United States. The value of different serologic screening tools and other noninvasive tests has been carefully assessed. HLA-DQ typing has been proposed as part of celiac disease screening testing for high-risk groups. The use of the newly defined pediatric Rome criteria is allowing recognition of nonulcer (or functional) dyspepsia as an entity that affects a sizable subset of children. Testing of gastric sensory and motor function is clarifying the pathophysiology of this condition in children and adolescents. Intriguing data are also emerging about the possible role of mucosal eosinophils and disaccharidase deficiencies in causing dyspeptic symptoms. Intrasphincteric injection of botulinum toxin A represents a novel technique to treat gastroparesis. In refractory cases, the use of a gastric electric stimulator has shown to be beneficial in idiopathic and diabetic gastroparesis. Progress has been made in understanding the epidemiology of Helicobacter pylori infection in developing countries and its role in causing a wide spectrum of symptoms in children. Several noninvasive methods for its diagnosis have been established. Summary: Recent developments in the diagnosis and management of gastric and duodenal pathologic conditions are making a significant impact on pediatric clinical care. Future studies will likely continue to explore the use of minimally invasive testing and interventions in such conditions.