PO-0103 Evaluation Of The Paediatric Patients With Gastrointestinal Bleeding: Experience Of A Tertiary Centre

Abstract

Introduction Gastrointestinal bleeding (GB) can be seen in children of all ages and it is one of the frequent application reason to paediatric gastroenterologists. Even though the causes of bleeding differs according to age groups, it may become life-threatening depending on the severity of the bleeding. Aim The aim of the study was to determine the demographical and etiological factors of patients who admitted to our clinic with upper or lower gastrointestinal bleeding. Material and method 94 patients, were included to the study, admitted to Uludag University Faculty of Medicine Paediatric Gastroenterology department with upper or lower gastrointestinal bleeding between January 2010 and June 2013. Patients' files were evaluated retrospectively. Results The number of patients with upper gastrointestinal bleeding (UGB) was 53, average ages of these patients was 11.1 years (2-18 years), 45.3% were female and 54.7% were male, respectively. At the aetiology of these bleeding cases H.pylori were detected in 18.8%, peptic or duodenal ulcer were detected in 10 patients (range of ages 10-18 years, average 12 years) and H.pylori was detected in only two patients with ulcer. While all gastric mucosa were hyperemic in 26 patients, distal esophagitis or duodenitis were detected also in 23 patients with UGB. Esophageal variceal bleeding was the cause of 4 patients with UGB and chronic renal failure was associated to bleeding in one patient. Barrett's oesophagus was detected histologically in 10 and 13 years of age two patients. Four patients had a history of nonsteroidal anti-inflammatory drug use prior to bleeding. Henoch-Schonlein disease was diagnosed in 7 years old male patient. Bleeding was the first symptom of this disease in this case and purpura was occurred after 4 days of bleeding. The remaining 41 cases were called idiopathic bleeding. Range of the ages of 41 patients with lower gastrointestinal bleeding (LGB) was 11.1 years and 24 patients were male (58.5% male, 41.5% female, respectively). Ulcerative colitis was diagnosed histologically in 9 patients (21.9%). Polip in rectum or sigmoid colon was detected in 6 patients, nonspesific chronic inflammation was reported pathologically in patients with polip and there were no family history for polip in these patients. Colonoscopy was normal in 13 patients (31.7%) with LGB. Conclusion Chronic gastritis was detected majority in aetiology of the patients with UGB and we thought that bad dietary habits had great importance in these cases. 21.9% cases with LGB were diagnosed with ulcerative colitis. All cases were evaluated, there were no death because of bleeding at the prognosis of these patients. Discussion Gastrointestinal bleeding is one of important reason for reference of tertiary centre in children. Considering the frequency of H.pylori positivity in our society, 18.8% were found to be positive in cases with UGB. Although the vast majority of patients with LGB were idiopatic, ulcerative colitis plays an important role in patients with LGB.