Causes of gastrointestinal bleeding in children based on endoscopic evaluation at a tertiary care center in Bahrain

Table 1 Demographic data of children presented with gastrointestinal bleeding

Variables	n (%)
Sex
Male	144 (57.6)
Female	106 (42.4)
Nationality
Bahraini	224 (89.6)
Non-Bahraini	24 (9.6)
Unspecified	2 (0.8)
Age group (yr) (n = 247)
0-4	58 (23.2)
5–9	82 (32.8)
10–18	107 (42.8)
Type of endoscopy performed
Upper gastrointestinal endoscopy	98 (39.2)
Lower gastrointestinal endoscopy	41 (16.4)
Both types of gastrointestinal endoscopies	111 (44.4)

Data are presented as numbers and percentages.

Table 2 Clinical presentation of children with gastrointestinal bleeding

Clinical presentation	Patients’ n (%)
Presenting symptoma
Per rectal bleeding	151 (60.4)
Hematemesis	117 (46.8)
Melena	25 (10)
Associated symptom
Recurrent abdominal pain	59 (23.6)
Diarrhea	23 (9.2)
Constipation	19 (7.6)
Recurrent vomiting	17 (6.8)
Weight loss	10 (4)
Chest pain	8 (3.2)
History of foreign body ingestion	7 (2.8)
Caustic ingestion	1 (0.4)
Nausea	1 (0.4)
Physical finding
Normal	218 (87.2)
Pallor	11 (4.4)
Perianal fissure	11 (4.4)
Perianal fistula	4 (1.6)
Jaundice	3 (1.2)
Failure to thrive	2 (0.8)
Oral ulcers	1 (0.4)

^aSome patients presented with more than one symptom. Data are presented as number and percentage.

Table 3 Causes of gastrointestinal bleeding in children in relation to age group

Causesa	Age group (yr)			Total, n (%)	P valueb
	0-4, n = 58 (23.2)	5-9, n = 82 (32.8)	10-18, n = 107 (42.8)
Inflammatory bowel disease	10 (17.2)	27 (32.9)	40 (37.4)	77 (30.8)	0.026
Gastritis	16 (27.6)	23 (28)	31 (29)	70 (28)	0.980
Unclear cause (normal)	3 (5.2)	4 (4.9)	17 (15.9)	24 (9.6)	0.017
Gastroenteritis	7 (12.1)	9 (11)	6 (5.6)	22 (8.8)	0.275
Duodenal ulcer	5 (8.6)	4 (4.9)	11 (10.3)	20 (8)	0.397
Esophagitis	4 (6.9)	5 (6.1)	6 (5.6)	15 (6)	0.947
Rectal polyp	6 (10.3)	5 (6.1)	4 (3.7)	15 (6)	0.237
Anal fissure	1 (1.7)	5 (6.1)	5 (4.7)	11 (4.4)	0.461
Peptic ulcer	4 (6.9)	4 (4.9)	1 (0.9)	9 (3.6)	0.114
Colonic ulcers	2 (3.4)	5 (6.1)	2 (1.9)	9 (3.6)	0.305
Rectal ulcer	0 (0)	2 (2.4)	7 (6.5)	9 (3.6)	0.078
Intestinal nodular lymphoid hyperplasia	4 (6.9)	4 (4.9)	0 (0)	8 (3.2)	0.034
Foreign body ingestion	6 (10.3)	1 (1.2)	0 (0)	7 (2.8)	< 0.0001
Esophageal varices	4 (6.9)	0 (0)	2 (1.9)	6 (2.4)	0.029
Esophageal ulcer	2 (3.4)	1 (1.2)	2 (1.9)	5 (2)	0.646
Meckel’s diverticulum	1 (1.7)	2 (2.4)	1 (0.9)	4 (1.6)	0.717
Mallory Weiss syndrome	1 (1.7)	2 (2.4)	0 (0)	3 (1.2)	0.291
Hemorrhoids	1 (1.7)	0 (0)	1 (0.9)	2 (0.8)	0.524
Duodenal varices	1 (1.7)	0 (0)	0 (0)	1 (0.4)	0.195
Colonic angiodysplasia	0 (0)	0 (0)	1 (0.9)	1 (0.4)	0.518
CMPA	1 (1.7)	0 (0)	0 (0)	1 (0.4)	0.195

^aSome patients may have more than one cause.

^bPearson χ². Data are presented as number and percentage. P value < 0.05 was considered statistically significant. CMPA: cow’s milk protein allergy.

Table 4 Summary of previous studies of gastrointestinal bleeding in children from neighboring countries and worldwide

Ref.	Country	n	Age (yr)	Sex	Bleeding site	Two most common symptoms (%)	Two most common causes (%)
Isa et al, 2023	Bahraina	250	≤ 18	M > F	Both	Per rectal bleeding (60.4); Hematemesis (46.8)	Inflammatory bowel disease (30.8); Gastritis (28)
Jafari et al[2], 2018	Iran	113	< 18	M > F	Both	Hematemesis (40.7); Coffee ground vomitus (38)	Prolapse gastropathy (18.6) for UGIB; Polyps (32.5) for LGIB
Rafeey et al[10], 2013	Iran	447	< 18	M > F	UGIB	Hematemesis (26.85); Melena (13.42)	Erosive esophagitis (40); Gastric erosion (17)
Zahmatkeshan et al[12], 2012	Iran	363	< 18	M > F	LGIB	Hematochezia (80.2); Bloody diarrhea (18.1)	Juvenile polyp (23.1); Lymphoid nodular hyperplasia (18.2)
Hassoon et al[9], 2012	Iraq	58	4 d-18	M > F	UGIB	Hematemesis (58.5); Melena or hematochezia (5.2)	Esophageal varices (39); Gastric erosions (19.6)
Gimiga et al[6], 2015	Romania	118	< 18	M > F	LGIB	Hematochezia (54.2); Rectorrhagia (40.7)	Solitary colorectal polyps (33); Ulcerative colitis (22)
Cleveland et al[4], 2012	USA	158	< 17	M > F	UGIB	Hematemesis (73.4); Melena (20.8)	Prolapse gastropathy syndrome (12.7); gastric erosions/ulcers (10.8)

^aThe present study. UGIB: upper gastrointestinal bleeding; LGIB: lower gastrointestinal bleeding; USA: United states of America.