Role of Gastroinestinal Endoscopy in Pediatric Failure to Thrive

Failure to thrive (FTT) is a common and concerning clinical presentation in pediatric practice, characterized by inadequate growth or the inability to maintain expected weight and height percentiles (1). By accepted definitions, FTT can be defined as weight-for-age below the 5th percentile, or a drop of two major percentile lines on a standardized growth chart (2). It is not a diagnosis but rather a descriptive term that reflects an underlying issue with inadequate energy intake, absorption, or utilization. The causes of FTT are broad and often multifactorial, ranging from nutritional deficiencies and feeding difficulties to chronic infections, metabolic disorders, and gastrointestinal (GI) diseases. Among these, GI causes are particularly important, as they may be subtle, chronic, and potentially reversible with early diagnosis and appropriate management (3).

Despite advances in nutritional support and non-invasive diagnostics, a subset of children with persistent FTT require further evaluation to identify underlying organic causes (4). Gastrointestinal endoscopy, including esophagogastroduodenoscopy (EGD) and colonoscopy, provides direct visualization, tissue sampling, and diagnosis of a wide spectrum of pathologies such as gastroesophageal reflux disease, eosinophilic esophagitis, celiac disease, inflammatory bowel disease, peptic ulcer disease, and malabsorptive disorders (5).

Children presenting with FTT and associated gastrointestinal symptoms such as persistent vomiting, chronic diarrhea, abdominal pain, dysphagia, feeding intolerance, or hematemesis are particularly likely to benefit from gastrointestinal endoscopy (6). Even in the absence of overt GI symptoms, some children with unexplained FTT may harbor asymptomatic or minimally symptomatic conditions detectable only through endoscopic and histologic examination. Furthermore, gastrointestinal endoscopy can also help to rule out serious pathologies and provide reassurance to caregivers, allowing clinicians to focus on non-organic or psychosocial contributors to FTT when appropriate (7).

Despite its clinical utility, the use of gastrointestinal endoscopy in evaluation of FTT must be carefully considered due to its invasive nature, the need for sedation or anesthesia, and potential complications (8). Therefore, patient selection and risk-benefit ratio assessment are crucial. The decision to perform gastrointestinal endoscopy is often guided by a combination of clinical findings, laboratory data, growth patterns, and failure to respond to initial nutritional interventions (9).

Inclusion criteria

• Age from 6 months to 18 years..
• Both sexes.
• Diagnosed with failure to thrive, defined as :

Weight-for-age below the 5th percentile for sex/age or crossing downward by ≥2 major percentiles, confirmed on two measurements.

• Clinical suspicion of an underlying gastrointestinal cause (e.g., chronic vomiting, chronic diarrhea either bloody or not, chronic abdominal pain and/or gastrointestinal bleeding
• Parental/guardian consent for their siblings to share in the study

Exclusion criteria

• Known chronic disease already causing failure to thrive (genetic, cardiac, renal, or endocrine disorders).
• Contraindications to endoscopy or anesthesia (e.g. severe coagulopathy, unstable cardiopulmonary status).
• Parental refusal to participate or consent for endoscopy