Robert W. Warren

Risks of endoscopy in hospitalized pediatric patients with collagen vascular diseases

BACKGROUND The gastrointestinal manifestations of the collagen vascular diseases have been well described in the pediatric population. These patients frequently have symptoms that constitute indications for endoscopy. However, the risks and benefits of endoscopy in this population have not been examined. METHODS A retrospective review of all patients with collagen vascular diseases hospitalized during a 7-year period was undertaken, and those patients who underwent endoscopy were identified. RESULTS Nine patients (5%) underwent endoscopic procedures (eight upper and three lower endoscopy). Complications and outcomes were analyzed. Indications for endoscopy included abdominal pain, gastrointestinal (GI) bleeding, and/or vomiting and diarrhea. Two patients had complications that required surgery within 1 day of the endoscopic procedure. One of these patients subsequently died with GI bleeding. Five of the nine patients had changes in their management after endoscopy. Helicobacter pylori infection was identified and treated in two patients. Three patients had esophagitis or gastritis and acid suppression treatment was started or optimized. Vasculopathy was present in the patients who had complications. CONCLUSIONS This series suggests that endoscopy can provide useful information for the management of the pediatric patient with GI symptoms and collagen vascular diseases. However, because serious and potentially life-threatening complications can occur, great care is needed in evaluating the risk/benefit ratio of endoscopy in these patients.

Pediatric rheumatic diseases

The rheumatic diseases of childhood are a relatively common and extraordinarily diverse group of illnesses; nevertheless, they are at least distantly related by similarities of immunodysregulation. These pathophysiologic relationships are reflected in affected children in similarities of historical, physical, and laboratory data as well as therapeutic intervention.

Visual Assessment of the Spine Bruckel Instrument, a Novel Status Tool to Reflect Appearance of the Spine in Patients with Ankylosing Spondylitis

Objective. The Visual Assessment of the Spine Bruckel Instrument (VASBI) is a new status tool developed by the Spondylitis Association of America and the University of Toronto to reflect spinal appearance in patients with ankylosing spondylitis (AS). Our objective was to validate the VASBI according to the Outcome Measures in Rheumatoid Arthritis Clinical Trials filter (truth, discrimination, and feasibility). Methods. Three hundred patients with AS were asked to rate their degree of perceived spinal deformity using the VASBI. To evaluate construct validity, VASBI scores were compared with functional outcome, spinal mobility, and radiographic spinal damage. Test-retest reliability was evaluated using kappa statistic (κ). Results. Patient VASBI demonstrated strong correlation with spinal mobility (r = 0.543) and moderate correlation with functional impairment (r = 0.490) and structural damage (r = 0.309). Reliability for VASBI was very good (κ = 0.973, p < 0.001). Conclusion. The VASBI is a novel tool with practical applications in a busy clinical setting as it simplifies assessment of AS spinal deformity. Our study demonstrates that the VASBI has good feasibility, construct validity, and reliability.

BENEFITS AND RISKS OF ENDOSCOPY IN PEDIATRIC PATIENTS WITH CHRONIC VASCULITIDES. 757

The gastrointestinal manifestations of collagen vascular diseases, such as systemic lupus erythematosus and polymyositis, have been well described in the pediatric population. These patients frequently have symptoms which are indications for endoscopic studies. However, the risks and benefits of gastrointestinal endoscopy in this population have not been examined. A complete review for all rheumatologic patients admitted to Texas Childrens Hospital during the past five years was performed and those patients undergoing endoscopy were identified. Ten patients (5%) underwent endoscopic procedures (nine upper and three lower endoscopies) which were analyzed with emphasis on resultant complications and therapeutic benefit. Indications for endoscopy included pain in six of ten patients, bleeding in three of ten patients and vomiting and diarrhea in one patient. Three patients had severe complications, two of which required surgery within one day of the endoscopic procedure. One of these patients subsequently died with GI bleeding. Five of the ten patients had changes in management following their endoscopy. Two patients had Helicobacter pylori and treatment was initiated. Three patients had esophagitis or gastritis and acid suppression treatment was started or optimized. Vasculopathy was present in the patients who had complications and may have contributed to their development. This study provides evidence that endoscopy can provide useful information for the management of the pediatric patient with GI symptoms and rheumatologic disease. However, since serious and potentially life-threatening complications occur, great care is needed in evaluating risk/benefit for endoscopic procedures in these high risk patients.