Etiology of Lower Gastrointestinal Bleeding in Children: A Single Center Experience from Southern Iran

Abstract

BACKGROUND

This study aimed to determine the common etiologies and character­istics of lower gastrointestinal (GI) bleeding in children from Southern Iran.

METHODS

This five-year prospective cross-sectional study was performed from March 2006 to March 2011 in Nemazee Hospital. All pediatric patients (<18 years of age) who referred to our center with visible lower GI bleed­ing or two consecutive positive occult blood tests with at least a one-week interval were included in the study. Patients were categorized as neonates (1-28 days), infants (29 days-2 years), children (2-10 years) and adoles­cents (>10 years) and the findings were reported separately in each group. Each patient underwent a colonoscopy and several mucosal biopsies were taken. Demographic and clinical information as well as colonoscopy and pathology findings were reported.

RESULTS

Overall, we included 363 pediatric patients with a mean age of 71.9±58.4 months (range: 1-216 months). There were 215 (59.2%) boys and 148 (40.8%) girls. The most common colonoscopy finding was sig­moid colon polyp in 91 (25.1%) patients followed by descending colon petechia in 78 (21.5%) patients, whitish rectal lesions in 45 (12.4%) pa­tients, and sigmoid and rectal ulcers in 37 (10.2%) patients. Biopsy sam­ples were non-specific in 96 (26.4%) patients. The most common patho­logical finding was juvenile polyp in 84 (23.1%) patients followed by lymphoid nodular hyperplasia in 55 (15.2%) patients and solitary rectal ulcers in 25 (6.9%) patients.

CONCLUSION

We found that lower GI bleeding was more common among 2-10 year-old children and was rarely encountered in neonates. Hematochezia was the most common form of presentation followed by bloody diarrhea and occult blood. The most common colonoscopy finding was sigmoid colon polyps and the most common pathological findings were juvenile polyps.