The Most Common Cause of Lower Gastrointestinal Bleeding without Other Symptoms in Children is Colonic Polyp: Is Total Colonoscopy Needed?

Lee, Yeoun Joo; Park, Jae Hong

doi:10.5946/ce.2019.084

Cited by 8 publications

(8 citation statements)

References 8 publications

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“…2 Meanwhile, multiple polyps are capable of being located in the proximal colon. 10,11 In one study, solitary polyps were observed in the left colon in 97% of patients in the non-polyposis group, while no patient in the polyposis syndrome group had only left colonic polyps. 12 In another study, among 45% of children with multiple polyps, 35% of the polyps have been reported to be distributed distal to the sigmoid colon.…”

Section: Discussionmentioning

confidence: 98%

Associations of Polyp Characteristics in Children and Adolescents Presenting with Less Than Five Colorectal Polyps: A Full Colonoscopy Is Still Required

Kim

Choi

et al. 2022

Gut and Liver

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Background/Aims: A full colonoscopy is currently required in children and adolescents with colorectal polyps, because of their potential of neoplastic transformation and complications such as intussusception. We aimed to analyze the associations of polyp characteristics in children and adolescents with colorectal polyps. Based on these findings, we also aimed to reevaluate the necessity of conducting a full colonoscopy.Methods: Pediatric patients <18 years of age who had undergone a colonoscopic polypectomy and those with <5 colorectal polyps were included in this multicenter, retrospective study. Baseline clinicodemographics, colonoscopic and histologic findings were investigated.Results: A total of 91 patients were included. Multivariate logistic regression analysis showed that polyp size was the only factor associated with the presence of any polyps located proximal to the splenic flexure (odds ratio [OR], 2.25; 95% confidence interval [CI], 1.28 to 4.28; p=0.007). Furthermore, polyp location proximal to the splenic flexure and sessile morphology were associated with the presence of any adenomatous polyp (OR, 8.51; 95% CI, 1.43 to 68.65; p=0.023; OR, 18.41; 95% CI, 3.45 to 173.81; p=0.002, respectively). Conclusions:In children and adolescents presenting with <5 colorectal polyps, polyp size and the presence of any adenomatous polyp were positively associated with polyp location proximal to the splenic flexure. This finding supports the necessity of a full colonoscopic exam in pediatric patients with colorectal polyps for the detection of polyps before the occurrence of complications such as intussusception or neoplastic transformation.

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Section: Discussionmentioning

confidence: 98%

Associations of Polyp Characteristics in Children and Adolescents Presenting with Less Than Five Colorectal Polyps: A Full Colonoscopy Is Still Required

Kim

Choi

et al. 2022

Gut and Liver

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“…In several studies, the most common cause of asymptomatic LGIB in children was colorectal polyps, especially in the Middle East, found in 25.1-41.6% of children undergoing colonoscopy [1,7,8,24]. They are less commonly found in Western populations [10,12,13].…”

Section: Discussionmentioning

confidence: 99%

A child with lower gastrointestinal bleeding – aetiology and diagnostic procedure

Jamer¹,

Maleika²,

Borys-Iwanicka³

et al. 2022

polp

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Introduction: Lower gastrointestinal bleeding (LGIB) is not a rare clinical problem in children. The aetiology of LGIB varies according to age. Likewise, experiences in different countries reflect the disparities in the frequency of various causes of LGIB in children. Although some cases can be diagnosed clinically, choosing the appropriate diagnostic methods in children is challenging. The aim of the study was to determine the aetiology of LGIB in children and analyse the diagnostic procedures needed to make a diagnosis. Material and methods:The medical records of children with chronic LGIB admitted to the Paediatric Gastroenterology Department were reviewed. The diagnoses and diagnostic procedures were analysed according to age groups (< 5 with subgroups < 2 and 2-5, 5-10, and > 10 years old). Results: 227 patients were enrolled in the study. The most important causes of LGIB among all patients were constipation associated with anal fissures (36.6%) and inflammatory bowel disease (IBD) (33.5%). According to age groups, the main causes of LGIB were: up to 5 years old -constipation (39.62%) and food allergy (28.3%), in the youngest age subgroup up to 2 years old -food allergy (52.38%), between 5 and 10 years old -constipation (44%) and ulcerative colitis (14%), over 10 years old -IBD ulcerative colitis (36.29%), Crohn's disease (13.71%), and constipation (32.26%). Patients with IBD were more likely to have anaemia and weight loss. The level of faecal calprotectin was significantly elevated in children with IBD and colorectal polyps. Conclusions: Constipation is a common cause of LGIB in all age groups of children. Food allergy should be considered in infants and young children, but it is rarely seen in children over 5 years old. In children older than 5 years old, diagnostics for IBD should be carried out, especially in patients with weight loss, high levels of faecal calprotectin, and anaemia. Colorectal polyps and Meckel's diverticulum are less common causes of LGIB.

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“…Colorectal polyps are the most common cause of isolated hematochezia in children. 1 2 3 4 However, in clinical settings, anal fissures may also present with isolated hematochezia. Therefore, distinguishing colorectal polyps from anal fissures may often be difficult, especially when the findings of anal inspection and digital rectal exam are negative.…”

Section: Introductionmentioning

confidence: 99%

Potential Utility of Fecal Calprotectin in Discriminating Colorectal Polyps From Other Major Etiologies in Children Presenting With Isolated Hematochezia

Kim

Choi

et al. 2022

J Korean Med Sci

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Background Colorectal polyps are the most common cause of isolated hematochezia in children, which requires a colonoscopy for diagnosis. We aimed to investigate the potential utility of fecal calprotectin (FC) in assessing colorectal polyps detected by colonoscopy among children presenting with isolated hematochezia. Methods Pediatric patients of the age of < 18 years who had undergone both colonoscopy and FC tests for isolated hematochezia from June 2016 to May 2020 were included in the present multicenter, retrospective, cross-sectional study. Comparative analysis was conducted between major causes of isolated hematochezia and FC cut-offs for discriminating colorectal polyps were explored. Results A total 127 patients were included. Thirty-five patients (27.6%) had colorectal polyps, followed by anal fissure (14.2%), ulcerative colitis (UC; 12.6%), and others. A significant difference in FC levels was observed between patients with colorectal polyps (median, 278.7 mg/kg), anal fissures (median, 42.2 mg/kg), and UC (median, 981 mg/kg) ( P < 0.001). According to receiver operating characteristic curve analysis, among patients diagnosed with colorectal polyp or anal fissure, the most accurate FC cut-off for discriminating colorectal polyps from anal fissures on colonoscopy was 225 mg/kg (sensitivity, 59.4%; specificity, 94.4%; positive predictive value [PPV], 95.0%; negative predictive value [NPV], 56.7%; area under the curve [AUC], 0.8; 95% confidence interval [CI], 0.678–0.923; P < 0.001), while among patients diagnosed with colorectal polyp or UC, the most accurate FC cut-off for discriminating colorectal polyps from UC on colonoscopy was 879 mg/kg (sensitivity, 81.2%; specificity, 56.2%; PPV, 78.8%; NPV, 60.0%; AUC, 0.687; 95% CI, 0.521–0.852; P < 0.001). Conclusion FC may assist in assessing the cause of lower gastrointestinal tract bleeding in children who present with isolated hematochezia.

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The Most Common Cause of Lower Gastrointestinal Bleeding without Other Symptoms in Children is Colonic Polyp: Is Total Colonoscopy Needed?

Cited by 8 publications

References 8 publications

Associations of Polyp Characteristics in Children and Adolescents Presenting with Less Than Five Colorectal Polyps: A Full Colonoscopy Is Still Required

Associations of Polyp Characteristics in Children and Adolescents Presenting with Less Than Five Colorectal Polyps: A Full Colonoscopy Is Still Required

A child with lower gastrointestinal bleeding – aetiology and diagnostic procedure

Potential Utility of Fecal Calprotectin in Discriminating Colorectal Polyps From Other Major Etiologies in Children Presenting With Isolated Hematochezia

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