DUODENITIS IN CHILDREN - CORRELATION OF RADIOLOGIC FINDINGS WITH ENDOSCOPIC AND PATHOLOGICAL FINDINGS

PURPOSE: To determine the accuracy of barium studies in the diagnosis of duodenitis in children. MATERIALS AND METHODS: Seventy-five childre n (45 boys and 30 girls;mean age,9 years) underwent upper gastrointest inal (GI) examinations. Twenty-four of the children had biopsy-proven duodenitis, and 51 were healthy control subjects. Radiologic findings were reviewed by two experienced, blinded observers and correlated wit h endoscopic and histologic results. Duodenal mucosal-fold thickness w as measured on spot radiographs (20% magnification), and the extent of disease was evaluated. RESULTS: Of 15 children with mild duodenitis, 13 had normal radiologic findings and 11 had normal findings at esopha gogastroduodenoscopy. Of nine children with severe duodenitis, all had friability or ulceration at endoscopy and mucosal-fold thickening of greater than or equal to 4 mm(greater than or equal to 3mm in one infa nt aged less than 1 year) at upper GI examination. Mucosal-fold thicke ning was diffuse in patients with celiac, autoimmune, an adenovirus di sease and was proximal in patients with peptic ulcer and Crohn disease . Of 51 control subjects, 50 had normal radiologic results, while 47 h ad normal endoscopic results. The sensitivity of upper GI examination for mild and severe duodenitis combined was 46% with a specificity of 98%, whereas endoscopy had a sensitivity of 54% and specificity of 92% . CONCLUSION: mucosal-fold thickening was a specific sign of duodeniti s in children and should be investigated. Upper GI examination yielded results similar to those at endoscopy.