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Gastrointestinal bleeding in children
S K Yachha1, A Khanduri, B C Sharma
1Department of Gastroenterology (Pediatric GE Section), Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
Insights
Gastrointestinal (GI) bleeding in children in developing countries differs from developed nations, with variceal bleeding common in the upper GI tract. Newer diagnostic tools aid in identifying causes of GI bleeding in pediatric patients.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Diagnostic Imaging
Background:
- Gastrointestinal (GI) bleeding is a significant concern in pediatric patients.
- Understanding the etiology of GI bleeding is crucial for effective management.
- Differences in disease prevalence between developed and developing countries necessitate localized research.
Purpose of the Study:
- To investigate the causes of GI bleeding in children in a developing country.
- To compare the spectrum of GI bleeding in children in a developing country with that in developed countries.
- To evaluate the utility of advanced diagnostic techniques in identifying the sources of GI bleeding in pediatric patients.
Main Methods:
- Prospective evaluation of 139 children with GI bleeding.
- Utilized barium studies, endoscopy, technetium-99m scans, digital subtraction angiography, and rectal endoscopic ultrasonography.
- Compared findings with established data from developed countries.
Main Results:
- Upper GI bleeding (75 cases) was predominantly variceal (95%), mainly due to extrahepatic portal venous obstruction.
- Lower GI bleeding (64 cases) causes included colitis (42%) and colorectal polyps (41%), similar to developed countries.
- Advanced imaging techniques like angiography and endoscopic ultrasonography proved helpful in diagnosis.
Conclusions:
- The etiology of upper GI bleeding in children differs significantly between developing and developed countries, with varices being the primary cause in the former.
- The causes of lower GI bleeding in children show similarities between developing and developed countries.
- Modern diagnostic modalities are safe and effective for diagnosing GI bleeding in pediatric populations.
Abstract:
We prospectively evaluated 139 consecutive children presenting to the Sanjay Gandhi Postgraduate Institute of Medical Sciences (Lucknow, India) with gastrointestinal (GI) bleeding from January 1991 to November 1994. Our aims were to find out whether the causes of GI bleeding in a developing country differed from developed countries and how the application of newer diagnostic techniques would help in the diagnosis of GI bleeding. Barium studies, endoscopy, technetium-99m-labelled (erythrocytes and pertechnetate) scans, selective abdominal angiography using a digital subtraction technique and rectal endoscopic ultrasonography were performed. Upper GI bleeding (n = 75) was variceal in 71 (95%) children (extrahepatic portal venous obstruction in 65, cirrhosis in six) and non-variceal in four (5%) cases (Henoch-Schonlein purpura, idiopathic thrombocytopenic purpura, drug-induced gastric erosions and pseudoaneurysm of the gastroduodenal artery due to idiopathic chronic calcific pancreatitis). Causes of lower GI bleeding (n = 64) were colitis (27 cases; 42%), colorectal polyps (26 cases; 41%), enteric fever (n = 3), solitary rectal ulcer (n = 3), portal hypertensive colopathy (n = 2), colonic arteriovenous malformation (n = 1) and internal haemorrhoids (n = 1). One patient remained undiagnosed. Angiography performed in four children was diagnostic in two. In one child with massive lower GI bleeding from portal colopathy, the bleeding site (caecum) was localized by intra-operative colonoscopy, while in the other child with portal colopathy, rectal endoscopic ultrasonography was performed to substantiate the diagnosis. We conclude that the causes of upper GI bleeding in children in developing countries are different from those in developed countries (variceal bleeding due to extrahepatic portal venous obstruction is the most common cause, while peptic ulcer is rare). However, the spectrum of lower GI bleeding is similar to that of developed countries. Application of newer diagnostic techniques is helpful and safe in the identification of the cause of GI bleeding in children.