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.
Highlights
GI bleed is known as upper GI bleed (UGIB) and lower GI bleed (LGIB) as per site of bleeding
After confirmation of bleeding as LGIB, proctosigmoidoscopy followed by colonoscopy is recommended among all cases for further evaluation and diagnosis.[3,7]
As no study has been done in South Punjab region of Pakistan to evaluate the etiology and outcome of LGIB among children, this study was planned to determine frequent etiologies and outcome of children with LGIB. This prospective study was done at Department of Pediatric Gastroenterology and Hepatology, Children’s Hospital and The Institute of Child’s Heath, Multan, Pakistan, from July 2019 to March 2020
Summary
GI bleed is known as upper GI bleed (UGIB) and lower GI bleed (LGIB) as per site of bleeding. Lower gastrointestinal bleeding (LGIB) is described as bleeding distal to the ligament of treitz and present as rectal bleeding.[1] Pathologies related to mucosa and vasculature of gastrointestinal (GI) tract may cause GI bleeding which is thought to be a serious presentation at any age.[2] LGIB usually present as hematochezia, melena, occult. After confirmation of bleeding as LGIB, proctosigmoidoscopy followed by colonoscopy is recommended among all cases for further evaluation and diagnosis.[3,7]
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