A school-age child has a 3-month history of dull, aching epigastric pain that worsens with eating and awakens the child from sleep. A complete blood count shows a hemoglobin of 8 mg/dL. What is the next step in management?

Question

Quizplus · Accepted Answer

The history and symptoms of epigastric pain worsened by eating and awakening the child from sleep, combined with a low hemoglobin, suggest a possible peptic ulcer or upper gastrointestinal bleeding. An EGD is the most appropriate next step in management to visualize the upper GI mucosa and potentially obtain biopsies for H. pylori testing or ruling out other underlying conditions. Administration of HRA or PPI medications and empiric therapy for H. pylori may be considered but should not be initiated without confirming the diagnosis through endoscopy. An upper GI series may also be considered, but EGD has better diagnostic yield and is preferred in cases of suspected peptic ulcer disease.

A School-Age Child Has a 3-Month History of Dull, Aching