The Significance Of Clinical Risk Factors In The Differential Diagnosis Of Upper Gastrointestinal Tract Pathologies In Infants With Vomiting Syndrome

Abstract

Vomiting syndrome is one of the most common clinical conditions encountered in pediatric practice and is predominantly functional in nature. However, this symptom may also represent a manifestation of serious organic pathologies of the upper gastrointestinal tract, particularly congenital hypertrophic pyloric stenosis. Early differential diagnosis between functional and organic conditions remains an important clinical challenge, especially in primary healthcare settings with limited access to instrumental diagnostic methods. Objective. To evaluate the diagnostic significance of clinical risk factors in predicting organic pathologies of the upper gastrointestinal tract in infants. Methods. The study included 89 infants presenting with vomiting syndrome, including 65 boys (73.0%) and 24 girls (27.0%). All patients underwent standardized clinical assessment including medical history evaluation, analysis of vomiting characteristics, weight dynamics, and physical examination findings. After diagnostic verification, patients were divided into two groups: an organic pathology group (n=45) and a functional disorder group (n=44). The diagnostic significance of clinical risk factors was assessed using the χ² test, odds ratio (OR), and 95% confidence interval (95% CI). Results. The majority of patients (79.8%) presented within the first three months of life. Statistical analysis demonstrated a significant association between several independent clinical factors and organic pathology. In particular, age under 3 months significantly increased the probability of organic pathology (OR=7.24; 95% CI: 2.00-26.2; p<0.001). Projectile vomiting (OR=5.97; 95% CI: 2.33-15.3; p<0.001) and male sex (OR=2.64; 95% CI: 1.05-6.61; p<0.05) were also identified as independent clinical predictors. Postprandial vomiting showed a strong association with organic pathology (OR=5.81; p<0.001), whereas recurrent vomiting did not demonstrate significant differential diagnostic value (p>0.05). Conclusion. In infants with vomiting syndrome, age below 3 months, projectile vomiting, postprandial vomiting, and male sex are significant independent clinical predictors of organic pathology. Comprehensive assessment of these factors may facilitate early identification of high-risk patients in primary pediatric care and ensure timely referral for specialized diagnostic evaluation.