Etiologies and outcome of lower gastrointestinal bleeding in patients presenting to a tertiary care Children’s Hospital

Abstract

Objective: To determine etiology and outcome of children with lower gastrointestinal bleeding (LGIB).
 Methods: This was a prospective study conducted at the Department of Pediatric Gastroenterology and Hepatology, Children’s Hospital and The Institute of Child’s Heath, Multan, Pakistan, from July 2019 to March 2020. A total of 148 cases presented with bleeding per rectum and underwent colonoscopy, were included. Children of both genders and aged three month to 15 years were included. Detailed history, clinical examination, laboratory studies, colonoscopy and histopathology were done in all cases. Study information like demographics, complaints, general clinical examination, colonoscopy and histopathological findings were recorded.
 Results: Overall, mean age was noted to be 7.20±1.83 years. Abdominal pain was reported in 41 (27.7%), diarrhea 36 (24.3%), fever 12 (8.1%) and constipation in 4 (2.7%). Pallor was noted among 68 (45.9%), weight loss 39 (26.3%) and tachycardia 31 (20.9%). Colonoscopy revealed juvenile colonic / rectal polyps, infectious colitis and solitary rectal ulcer (SRU) as the most common etiologies found among 58 (39.2%), 20 (13.5%) and 19 (12.8%) cases respectively. Juvenile polyps and non-specific colitis were the commonest histopathological findings seen in 55 (37.2%) and 20 (13.5%) cases respectively. Colonoscopic polypectomy was used to remove all juvenile polyps.
 Conclusion: LGIB is presentation of various underlying causes. Children with LGIB commonly present with abdominal pain. Juvenile polyps were the most frequent cause of LGIB among children flowed by non-specific colitis. Most of the children having LGIB were diagnosed and treated successfully, few are in remission and very few were found resistant to treatment.
 doi: https://doi.org/10.12669/pjms.37.2.2676
 How to cite this:Talib MA, Aziz MT, Suleman H, Khosa GK, Joya SJ, Hussain I. Etiologies and outcome of lower gastrointestinal bleeding in patients presenting to a tertiary care Children’s Hospital. Pak J Med Sci. 2021;37(2):---------. doi: https://doi.org/10.12669/pjms.37.2.2676
 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Causes and Outcome of Children with Lower Gastrointestinal Bleeding (LGIB) Presenting at Tertiary Care Hospital

“…Based on the clinical examination, pallor was observed amongst 115 (46%) patients, weight loss in 52 (20.8%) patients and tachycardia was observed in 45 (18%) patients while hypotension was observed in 38 (15.2%) in the current study. Other previous studies reported similar observations 14,16,17 . Juvenile colonic or rectal polyps were the most frequent finding in the present investigation, occurring in 36.4 per cent of cases.…”

“…Another study done in India reported high male to female ratio (2.16:1) amongst children with LGIB undergoing colonoscopy17 . Another study also reported comparable findings14 . The mean age was 6.80 (± 1.50) years in our study.…”

“…The most common reason for referring children to pediatric gastroenterology centers is LGIB 15 14,16,17 . According to a research conducted in Iran, children under the age of 10 made up 79.9% of the patients who presented with LGIB 18 .…”

“…Several mucosal biopsies were performed when the mucosa and vasculature were clearly visible. Biopsy samples were transferred to the institution's laboratory for assessment while being fixed in phosphate-buffered formalin 14 . All polyps were removed using a colonoscopic polypectomy, and the polyps were then sent for histology.…”

Nguyên Nhân Và Đặc Điểm Lâm Sàng Của Xuất Huyết Tiêu Hoá Dưới Ở Trẻ Em Tại Bệnh Viện Nhi Trung Ương

“…Phân bố giới tính trong nghiên cứu của chúng tôi tương tự với các nghiên cứu trong nước và trên thế giới. XHTH dưới có xu hướng gặp ở trẻ trai nhiều hơn trẻ gái, tỷ lệ trẻ trai/trẻ gái trong nghiên cứu của Lê Quang Quỳnh là 2,1/1 3 và Muhammad Abu Talib (2021) là 1,3/1 4 . Tuổi trung bình là 5,5 ± 4,6 tuổi (Bảng 1).…”