Retrospective Cohort Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Apr 16, 2023; 15(4): 297-308
Published online Apr 16, 2023. doi: 10.4253/wjge.v15.i4.297
Causes of gastrointestinal bleeding in children based on endoscopic evaluation at a tertiary care center in Bahrain
Hasan M Isa, Fatema A Alkharsi, Hana A Ebrahim, Kamel J Walwil, Jumana A Diab, Nafelah M Alkowari
Hasan M Isa, Fatema A Alkharsi, Department of Pediatrics, Salmaniya Medical Complex, Manama 26671, Bahrain
Hasan M Isa, Department of Pediatrics, Arabian Gulf University, Manama 26671, Bahrain
Hana A Ebrahim, Kamel J Walwil, Jumana A Diab, Department of Pediatrics, Royal College of Surgeons in Ireland-Medical University of Bahrain, Busaiteen 15503, Bahrain
Nafelah M Alkowari, Department of Pediatrics, King Hamad University Hospital, Muharraq 24343, Bahrain
Author contributions: Isa HM was the main contributor in study design, literature review, data analysis, drafting manuscript, and over-sight for all phases of the project and the final approval of the version to be published; Alkharsi FA was responsible for literature review, data collection, drafting and revising manuscript; Ebrahim HA, Walwil KJ and Diab JA were responsible for literature review, data collection and revising manuscript; Alkowari NM was responsible for literature review, drafting and revising manuscript; All the authors have read and approved the final manuscript.
Institutional review board statement: This study was ethically approved by the Research and Research Ethics Committee, Salmaniya Medical Complex, Government hospitals, Kingdom of Bahrain (IRB number: 6170122, January 17, 2022).
Informed consent statement: Consent was not needed as the study was retrospective without exposure to the patients’ data.
Conflict-of-interest statement: All the Authors have no conflict of interest related to the manuscript.
Data sharing statement: Data are available upon reasonable request.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hasan M Isa, MBChB, Associate Professor, Department of Pediatrics, Salmaniya Medical Complex, Arabian Gulf University, Manama 26671, Bahrain. halfaraj@hotmail.com
Received: December 17, 2022
Peer-review started: December 17, 2022
First decision: January 12, 2023
Revised: January 23, 2023
Accepted: March 17, 2023
Article in press: March 17, 2023
Published online: April 16, 2023
Processing time: 117 Days and 13.3 Hours
Abstract
BACKGROUND

Gastrointestinal bleeding (GIB) is a serious health problem worldwide, particularly during childhood. This can be an alarming sign of an underlying disease. Gastrointestinal endoscopy (GIE) is a safe method for the diagnosis and treatment of GIB in most cases.

AIM

To determine the incidence, clinical presentation, and outcomes of GIB in children in Bahrain over the last two decades.

METHODS

This was a retrospective cohort review of the medical records of children with GIB who underwent endoscopic procedures in the Pediatric Department at Salmaniya Medical Complex, Bahrain, between 1995 and 2022. Demographic data, clinical presentation, endoscopic findings, and clinical outcomes were recorded. GIB was classified into upper (UGIB) and lower (LGIB) GIB according to the site of bleeding. These were compared with respect to patients’ sex, age, and nationality using the Fisher’s exact, Pearson’s χ2, or the Mann-Whitney U tests.

RESULTS

A total of 250 patients were included in this study. The median incidence was 2.6/100000 per year (interquartile range, 1.4-3.7) with a significantly increasing trend over the last two decades (P < 0.0001). Most patients were males (n = 144, 57.6%). The median age at diagnosis was 9 years (5–11). Ninety-eight (39.2%) patients required upper GIE alone, 41 (16.4%) required colonoscopy alone, and 111 (44.4%) required both. LGIB was more frequent (n = 151, 60.4%) than UGIB (n = 119, 47.6%). There were no significant differences in sex (P = 0.710), age (P = 0.185), or nationality (P = 0.525) between the two groups. Abnormal endoscopic findings were detected in 226 (90.4%) patients. The common cause of LGIB was inflammatory bowel disease (IBD) (n = 77, 30.8%). The common cause of UGIB was gastritis (n = 70, 28%). IBD and undetermined cause for bleeding were higher in the 10–18 years group (P = 0.026 and P = 0.017, respectively). Intestinal nodular lymphoid hyperplasia, foreign body ingestion, and esophageal varices were more common in the 0–4 years group (P = 0.034, P < 0.0001, and P = 0.029, respectively). Ten (4%) patients underwent one or more therapeutic interventions. The median follow-up period was two years (0.5-3). No mortality was reported in this study.

CONCLUSION

GIB in children is an alarming condition, whose significance is increasing. LGIB, commonly due to IBD, was more common than UGIB, commonly due to gastritis.

Keywords: Pediatric; Gastrointestinal bleeding; Endoscopy; Causes; Outcome; Bahrain

Core Tip: The incidence, clinical presentation, cause, and outcomes of gastrointestinal bleeding (GIB) in children in Bahrain are unknown. We observed a significant increase in the annual incidence of GIB. Lower GIB (LGIB) was more common than upper GIB (UGIB). The most common cause of LGIB was inflammatory bowel disease. The most common cause of UGIB was gastritis. Causes of GIB varied with patient’s age and differed from that reported in other countries. No mortality was observed in any patient. These findings are essential to tailor management based on the most common causes and patient age.