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Gastrointestinal Bleeding in Children: The Role of Endoscopy and the Sheffield Scoring System in a Resource-Limited
Oluwafunmilayo Funke Adeniyi1, Olufunmilayo Adenike Lesi2, Emuobor Aghoghor Odeghe2
1From the Department of Paediatrics, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria.
Insights
The Sheffield score effectively predicted gastrointestinal bleeding severity in Nigerian children, but limited endoscopy access hindered its full utility. Further resources are needed to improve pediatric GI care.
Area of Science:
- Pediatric Gastroenterology
- Clinical Endoscopy
- Diagnostic Scoring Systems
Background:
- Gastrointestinal (GI) bleeding is a significant concern in children.
- Accurate assessment and timely endoscopic intervention are crucial for managing pediatric GI bleeds.
- The Sheffield score is a tool to assess the severity and predict outcomes of GI bleeding.
Purpose of the Study:
- To document the clinical presentation, endoscopic findings, and Sheffield scores in Nigerian children with GI bleeding.
- To evaluate the utility of the Sheffield score in predicting outcomes such as rebleeding, mortality, and need for endoscopic intervention.
- To assess the diagnostic yield of endoscopy in this pediatric population.
Main Methods:
- Retrospective analysis of 111 children's records (2013-2021) and prospective recruitment of 9 children (2021-2022).
- Evaluation of clinical presentation, endoscopic diagnoses, and Sheffield scores.
- Use of receiver operating characteristic (ROC) curves to assess the predictive ability of Sheffield scores for adverse outcomes.
Main Results:
- 120 children were included; 91 (75.8%) had upper GI bleeding (UGIB) and 29 (24.2%) had lower GI bleeding (LGIB).
- Endoscopy was performed on 70 (58.3%) participants, identifying causes like variceal/nonvariceal bleeding (UGIB) and juvenile polyps/colitis (LGIB).
- A Sheffield score ≥8 was observed in 46.1% of UGIB patients and was significantly related to bleed type, rebleeds, and mortality (P=0.00).
Conclusions:
- Clinical and endoscopic findings align with previous studies.
- The Sheffield scoring system demonstrated utility in assessing Nigerian children with GI bleeding.
- Suboptimal availability and utility of GI endoscopy due to limited resources necessitate improved equipment, resources, and personnel training.
Objective:
To document the clinical presentation, endoscopic diagnosis, and Sheffield scores of children with gastrointestinal (GI) bleeding who were referred for endoscopy at the Lagos University Teaching Hospital. The participants who needed endoscopy based on clinical criteria and according to the Sheffield scores were also documented.
Methods:
This study analyzed the records of 111 children with GI bleeding retrospectively from January 2013 to January 2021, while 9 children were recruited prospectively from February 2021 to March 2022. Receiver operating curves and area under the curve were generated to test the ability of the Sheffield scores to predict rebleeds, mortality, and the need for endoscopic intervention for upper GI bleeds.
Results:
One hundred and twenty participants were recruited. Ninety-one (75.8%) presented with upper GI bleeding (UGIB), while 29 (24.2%) had lower GI bleeding (LGIB). Only 70 (58.3%) (53 UGIB and 17 LGIB) had endoscopy performed. For UGIB, 5 (9.4%) had no source of the bleeding identified at endoscopy, 12 (22.6%) had variceal bleeding, and 36 (67.9%) had nonvariceal bleeding. Colonoscopy revealed juvenile polyps in 5 (29.4%), indeterminate colitis in 5 (29.4%), ulcerative colitis in 4 (23.5%), Crohn's disease in 1 (5.9%), and hemorrhoids in 2 (11.8%) participants, respectively. The Sheffield score was ≥8 in 42 (46.1%) of the participants who presented only with UGIB (hematemesis and melena). The scores were significantly related to the type of bleeds, rebleeds, and deaths (P = 0.00).
Conclusion:
The clinical and endoscopic findings in this study are similar to those reported previously. The Sheffield scoring was useful in assessing Nigerian children. However, due to limited access and other restraints, endoscopy was not performed on all the study participants even when the scoring system was suggestive. The availability, and therefore, utility of GI endoscopy in this setting are still suboptimal. The need for the provision of adequate equipment and resources and the training of personnel is thus recommended.
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