Abstract
Objectives. Identification of clinical, endoscopic, etiological characteristic of children diagnosed with upper and lower gastrointestinal bleeding. Material and methods. It was conducted a descriptive retrospective study over a 3 year period (January 2010 to December 2012) on 107 children aged 1-18 years hospitalized for gastrointestinal bleeding in ”St. Mary” Children’s Emergency Hospital, Iasi. The study group does not include gastrointestinal bleeding from surgical emergencies, infectious diseases, intestinal diseases with immunological or toxic mechanism. Individualized retrospective analysis included historical data, clinical, endoscopic and histological targeted for etiologic diagnosis of gastrointestinal bleeding. All patients were investigated by upper gastrointestinal endoscopy/colonoscopy after the procedure was explained and informed consent was obtained. Results. From the batch of 107 children, 39 (36.4%) presented with upper gastrointestinal bleeding (UGIB) 6 (5.1%) was variceal, non-variceal in 33 (94.4%) cases, and 68 (63.5%) presented with lower gastrointestinal bleeding (LGIB) The main etiological aspect of UGB was erosive gastritis 30.8%, esophagitis in 15.4%, duodenitis in 15.4%, gastric and duodenal ulcers 5,1% and respectively 10.3% of cases, Mallory-Weiss syndrome in 2.6%, multiple etiology in 10 cases 15.4%. Causes of LGIB were colorectal polyps in 41.2.%, ulcerative colitis 20.6%, non specific lesions in 17.6% anal fissures 13.2%, intestinal polyposis 4.4 %,rectal diverticula 1.5% and vascular malformations 1.5%. It was practiced concomitant endoscopic surgery for rectal polyps. Conclusions. Lower gastrointestinal bleeding was the most common causes related to minor conditions: colorectal polyps, anal fissures, nonspecific lesions. Non-variceal gastrointestinal bleeding the most common form associated with erosive gastritis, esophagitis, duodenal ulcer, gastric ulcer. Endoscopy proved to be a useful investigation in the diagnosis of gastrointestinal bleeding and a therapeutic useful tool in certain cases.
Highlights
Gastrointestinal bleeding remains one of the largest, frequent and important emergency of pediatric gastroenterology, in terms of both diagnostic and therapeutic approach.The incidence of digestive haemorrhage is not very well established, in Europe being 0,4-1,6% for upper gastrointestinal bleeding [1] while the lower gastrointestinal haemorrhage totalize 0.3% of emergency presentations. [2]In paediatric practice there are described various etiological aspects, from benign conditions which require no treatment to severe and potential lethal etiologies that require immediate intervention
We included in the study 107 patients with documented upper and lower gastrointestinal bleeding who were addressed to our clinic during the study period of time
The most common cause of lower gastrointestinal bleeding in the Middle East, Western countries and the Chinese population was –colorectal polyp [5, 17,18] In Egyptian population the main cause of lower gastrointestinal bleeding is infectious colitis followed by colorectal polyp. [19]The most common form of polyps were usually solitary juvenile polyps, we had only 3 cases of intestinal polyposis where we found polyps sized between 0.5-2 cm
Summary
Gastrointestinal bleeding remains one of the largest, frequent and important emergency of pediatric gastroenterology, in terms of both diagnostic and therapeutic approach.The incidence of digestive haemorrhage is not very well established, in Europe being 0,4-1,6% for upper gastrointestinal bleeding [1] while the lower gastrointestinal haemorrhage totalize 0.3% of emergency presentations. [2]In paediatric practice there are described various etiological aspects, from benign conditions which require no treatment to severe and potential lethal etiologies that require immediate intervention.
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