Background: Most patients with chronic lower gastrointestinal (GI) bleeding warrant endoscopic examination of the lower GI tract. This study was done to determine the etiological profile of chronic lower GI bleeding and the role of colonoscopy in its diagnosis, as well as the prognosis among children from sub‑Himalayan ranges of North India. Methods: In this study, we did a retrospective review of the clinical notes of children between 2 and 15 years of age who presented with chronic lower GI bleeding and underwent diagnostic and therapeutic colonoscopy in the Department of Gastroenterology, Indira Gandhi Medical College and Hospital, Shimla, from January 2012 to October 2017. Patient demographics, clinical features, and endoscopic and histopathological findings were recorded. Results: Of the total 57 patients reviewed, 22 (38.59%) were female and 35 (61.40%) were male, with a male‑to‑female ratio of 1.62:1.0. The highest incidence of lower GI bleeding was between the ages of 6 and 10 years (43.85%). The presenting symptoms were hematochezia in 50 (87.71%), bloody diarrhea in 5 (8.77%), and positive stool occult blood test in 2 (3.50%) patients. The most common accompanying symptom was constipation in 16 (28.07%), abdominal pain in 14 (24.56%), fever in 5 (8.77%), and weight loss in 5 (8.77%) patients. The most common colonoscopy finding was rectosigmoid polyps (36 cases, 63.15%) followed by internal hemorrhoids (9 cases, 15.78%), rectal ulcers (5 cases, 8.77%), findings suggestive of colitis of left colon (5 cases, 8.77%), and findings suggestive of ileocecal tuberculosis (2 cases, 3.50%). The most common histopathological finding was juvenile colorectal polyps (35 cases, 61.40%) followed by solitary rectal ulcer (5 cases, 8.77%), ulcerative colitis (5 cases, 8.77%), tuberculosis (2 cases, 3.50%), and Peutz–Jegher polyp (1 case, 1.75%). Conclusion: Juvenile colorectal polyps constitute the most common cause of chronic lower GI bleeding in children from sub‑Himalayan ranges of North India followed by hemorrhoids, solitary rectal ulcer, inflammatory bowel disease, and ileocolonic tuberculosis. Colonoscopy remains a useful and safe procedure in children for evaluation of lower GI bleeding both from the diagnostic and therapeutic points of view.

No abstract

Background Lower gastrointestinal bleeding (LGIB) is fairly a common presentation in gastroenterology and medicine departments, and presents major diagnostic and therapeutic challenges. This study aimed to explore the varied clinical spectrum of LGIB in our region. Methods A total of 138 patients presented with chronic LGIB and were investigated using colonoscopy and relevant investigations. Results The majority of patients were in the age group of 40 to 59 years, with a mean age of 49.5 years, slight male predominance, and male-to-female ratio of 1.19:1. The most common clinical presentation was hematochezia (97.8%). Overall, 15% patients had more than one comorbidity, and 39.13% patients were anemic, of which 7.24% received blood transfusions. Diagnostic yield of colonoscopy was 92.75%. Major causes of LGIB were anorectal causes (19.56%), inflammatory bowel disease (19.56%), colorectal carcinoma (17.39%), radiation proctitis (9.42%), infective causes (11.59%), nonspecific colitis (7.24%), and benign growths (5.07%). However, in the elderly (age > 60 years), carcinoma colon, radiation proctitis, and hemorrhoids predominated the clinical picture. Conclusion Colonoscopy is very useful in the evaluation of patients with LGIB. The predominant causes of LGIB vary according to age as well as geographical location, and mortality of LGIB is negligible as compared with upper gastrointestinal bleeding. Abstract, Keywords ► lower gastrointestinal bleeding ► inflammatory bowel disease ► solitary rectal ulcer syndrome ► colonoscopy

Systemic lupus erythematosus (SLE) is an autoimmune disorder generally affects young to middle-aged women, commonly presenting as a triad of fever, rash, and joint pain but can affect multiple organs and can present in a complex fashion, varying based on the degree and severity of organ involvement. The differential for abdominal pain and diarrhea in SLE is vast and can include VIPomas, serositis, pancreatitis, intestinal vasculitis, and protein – losing enteropathy, gluten – enteropathy, intestinal pseudo-obstruction, and infection. The pathology of lupus enterits thought to be immune-complex deposition and complement activation, with subsequent mucosal edema. We present a case of a woman with no history of SLE, but with a prolonged course of abdominal pain, diarrhoea and vomiting and eventual diagnoses of lupus enteritis.