Recurrent Abdominal Pain and Exocrine Pancreatic Insufficiency
Recurrent Abdominal Pain and Exocrine Pancreatic Insufficiency
This is a 3-year prospective study too identify the role of exocrine pancreatic insufficiency
 in patients with abdominal pain who are undergoing upper endoscopy. An endoscopic pancreatic
 function test (ePFT) with secretin will be performed in children undergoing routine
 investigative EGD.

 The goal of this study is to identify the role of exocrine pancreatic insufficiency in
 patients with abdominal pain who are undergoing upper endoscopy, who otherwise would be
 labelled as recurrent abdominal pain (RAP).
Recurrent abdominal pain (RAP) is an often encountered complaint in children and adolescents.
 The evaluation of the child or adolescent with recurrent abdominal pain requires an
 understanding of the pathogenesis of abdominal pain, the most common causes of abdominal
 pain, and the typical patterns of presentation.

 Children and adolescents frequently undergo esophagogastroduodenoscopy (EGD) to evaluate
 complaint and recurrent abdominal pain is a frequently cited reason for endoscopy. This is a
 standard procedure where an endoscope is passed through the mouth, esophagus, stomach and
 into the first part of the small intestine. With the camera at the end of the endoscope, the
 endoscopist is able to see the gross appearance of the upper digestive tract. Small biopsy
 samples are collected from the small intestine, stomach and esophagus to evaluate for mucosal
 injury, irritation, infection or other anomalies that could be contributing to the patient's
 symptoms. This is helpful for evaluation of histological changes, but does not provide
 information about its function.

 Pancreatic stimulation testing with secretagogue (secretin, cholecystokinin) administration,
 and direct pancreatic fluid collection is considered a gold standard to assess the exocrine
 pancreatic function. Indirect testing of pancreatic function such as with urine or stool has
 much lower sensitivity and specificity compared to direct pancreatic fluid collection.

 This is a prospective study where patients undergoing investigative EGD will have endoscopic
 pancreatic function test (ePFT) with secretin.

 There will be two groups:

 The first group are patients that are undergoing EGD with ePFT for evaluation of suspected or
 established pancreatic insufficiency with symptoms such as failure to thrive or
 malabsorption. These patients are the ones that historically have had ePFT testing done to
 evaluate their pancreatic function.

 The second group is all patients that are undergoing scheduled diagnostic EGD for other
 reasons that consent for pancreatic stimulation testing. These patients are usually
 undergoing EGD for a range of symptoms that frequently include recurrent abdominal pain,
 bloating, diarrhea, nausea and/or constipation. These patients do not typically have ePFT
 testing performed and is not usually thought to be part of the standard of care for this
 group.
Inclusion Criteria:

 -  For Group 1- Patients undergoing EGD with ePFT for symptoms of suspected or known
 pancreatic insufficiency

 -  For Group 2- Patients undergoing diagnostic EGD who consent to undergo ePFT

 Exclusion Criteria:

 -  If it is an emergency EGD procedure

 -  If the caregiver refuses to sign the consent form

 -  Patient has undergone ePFT testing previously with a documented allergy to human
 secretin

 -  Patients that require atropine at the time of sedation