Seyed Mohsen DEHGHANI, Iraj SHAHRAMIAN, Ali BAZI, Mojtaba DELARAMNASAB, Maryam ATAOLLAHI, Nosaibe SEIRFAR, Alireza SARGAZI, Mahsa SHARIATRAZAVI

A survey on rectal bleeding in children, a report from Iran

Background/aim: Studies on the epidemiology of rectal bleeding in children are limited in Iran. Our aim was to assess etiologies ofrectal bleeding in children in Iran.Materials and methods: We enrolled 730 children with rectal bleeding. All the patients underwent colonoscopy, and 457 were furtherevaluated with histopathology.Results: According to colonoscopy and histopathology, respectively, inflammatory bowel disease (IBD) (29.4%, 15.8%), nodularhyperplasia (NH) (24.9%, 10%), and juvenile polyposis (JP) (12.6%, 9.9%) were the most common causes of rectal bleeding. Otherconditions were solitary rectal ulcer (5.3%), chronic colitis (4.6%), allergic colitis (3.3%), focal colitis (1.3%), and infectious colitis(1.1%). In colonoscopy, there were no significant differences in the distribution of pathologies regarding sex, while the youngest andoldest mean ages were found for patients with NH (4.6 ± 3.9 years, P < 0.0001) and those with normal appearance (8.1 ± 4.4 years, P< 0.0001) respectively. Based on histopathologic reports, the youngest patients were diagnosed with infectious colitis (4.6 ± 2.8 years),while patients with chronic colitis were the oldest (9.2 ± 4.6 years, P = 0.003).Conclusion: JP, NH, and IBD constituted the most common etiologies of rectal bleeding in our patients. It is recommended to performa complete diagnostic approach to accurately assess rectal bleeding in children.

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Walker CLF, Sack D, Black RE. Etiology of diarrhea in older children, adolescents and adults: a systematic review. PLoS Negl Trop Dis 2010; 4: e768.
Kapoor A, Bhatia V, Sibal A. Pediatric inflammatory bowel disease. Indian Pediatr 2016; 53: 993-1002.
Escher J. Inflammatory bowel disease in children and adolescents: recommendations for diagnosis-the Porto criteria. J Pediatr Gastroenterol Nutr 2005; 41: 1-7.
Fishman LN, Mitchell PD, Lakin PR, Masciarelli L, Flier SN. Are expectations too high for transitioning adolescents with inflammatory bowel disease? Examining adult medication knowledge and self-management skills. J Pediatr Gastroenterol Nutr 2016; 63: 494-499.
Rosen MJ, Dhawan A, Saeed SA. Inflammatory bowel disease in children and adolescents. JAMA Pediatr 2015; 169: 1053-60.
Strisciuglio C, Giugliano F, Martinelli M, Cenni S, Greco L, Staiano A, Miele E. Impact of environmental and familial factors in a cohort of pediatric patients with inflammatory bowel disease. J Pediatr Gastroenterol Nutr 2017; 64: 569-574.
Varni JW, Shulman RJ, Self MM, Saeed SA, Patel AS, Nurko S, Neigut DA, Saps M, Franciosi JP, Denham JM et al. Gastrointestinal symptoms predictors of health-related quality of life in patients with inflammatory bowel disease. J Pediatr Gastroenterol Nutr 2016; 63: E186-E92.
Thakkar K, Alsarraj A, Fong E, Holub JL, Gilger MA, El Serag HB. Prevalence of colorectal polyps in pediatric colonoscopy. Dig Dis Sci 2012; 57: 1050-1055.
Caiulo S, Moramarco F, Caiulo VA. Juvenile polyp. Eur J Pediatr 2014; 173: 125.
Haghighat M, Dehghani SM, Shahramian I, Imanieh MH, Teimouri A, Noori NM. Combination of erythromycin and propranolol for treatment of childhood cyclic vomiting syndrome: a novel regimen. Gastroenterol Hepatol Bed Bench 2015; 8: 270.
Mandhan P. Juvenile colorectal polyps in children: experience in Pakistan. Pediatr Surg Int 2004; 20: 339-342.
Gupta SK, Fitzgerald JF, Croffie JM, Chong SK, Pfefferkorn MC, Davis MM, Faught PR. Experience with juvenile polyps in North American children: the need for pancolonoscopy. Am J Gastroenterol 2001; 96: 1695-1697.
Manfredi MA, Fox VL, Zurakowski D, Kutok JL, Glickman JN, Moses MA. Matrix metalloproteinases in the urine and tissue of patients with juvenile polyps: potential biomarkers for the presence of polyps. J Pediatr Gastroenterol Nutr 2009; 48: 405- 411.
Levine A, Koletzko S, Turner D, Escher JC, Cucchiara S, De Ridder L, Kolho KL, Veres G, Russell RK, Paerregaard A. ESPGHAN revised Porto criteria for the diagnosis of inflammatory bowel disease in children and adolescents. J Pediatr Gastroenterol Nutr 2014; 58: 795-806.
Moravej H, Dehghani SM, Nikzadeh H, Malekpour A. Lower gastrointestinal bleeding in children: experiences from referral center in southern Iran. Journal of Comprehensive Pediatrics 2013; 4: 115-118.
Dehghani SM, Erjaee A, Abolfathi L, Honar N, Imanieh MH, Haghighat M. Epidemiology of pediatric inflammatory bowel diseases in Southern Iran. Middle East Journal of Digestive Diseases 2012; 4: 102.
Olafsdottir I, Nemeth A, Lorinc E, Toth E, Agardh D. Value of fecal calprotectin as a biomarker for juvenile polyps in children investigated with colonoscopy. J Pediatr Gastroenterol Nutr 2016; 62: 43-46.
Fagerberg UL, Lööf L, Myrdal U, Hansson L-O, Finkel Y. Colorectal inflammation is well predicted by fecal calprotectin in children with gastrointestinal symptoms. J Pediatr Gastroenterol Nutr 2005; 40: 450-455.
Van de Vijver E, Schreuder AB, Cnossen WR, Kobold ACM, van Rheenen PF. Safely ruling out inflammatory bowel disease in children and teenagers without referral for endoscopy. Arch Dis Child 2012 ;97: 1014-1018.
Khan K, Schwarzenberg SJ, Sharp H, Greenwood D, Weisdorf‐ Schindele S. Role of serology and routine laboratory tests in childhood inflammatory bowel disease. Inflamm Bowel Dis 2002; 8: 325-329.
El-Chammas K, Majeskie A, Simpson P, Sood M, Miranda A. Red flags in children with chronic abdominal pain and crohn’s disease–a single center experience. J Pediatr 2013; 162: 783- 787.
Perminow G, Brackmann S, Lyckander LG, Franke A, Borthne A, Rydning A, Aamodt G, Schreiber S, Vatn MH; IBSEN-II Group. A characterization in childhood inflammatory bowel disease, a new population-based inception cohort from SouthEastern Norway, 2005–07, showing increased incidence in Crohn’s disease. Scand J Gastroenterol 2009; 44: 446-456.
Sidler MA, Leach ST, Day AS. Fecal S100A12 and fecal calprotectin as noninvasive markers for inflammatory bowel disease in children. Inflamm Bowel Dis 2008; 14: 359-366.
Schwerd T, Koletzko S. Inflammatory bowel disease. Monatsschrift Kinderheilkunde 2017; 165: 257-267.
Ahlawat R, Weinstein T, Pettei MJ. Vitamin D in pediatric gastrointestinal disease. Curr Opin Pediatr 2017; 29: 122-127.
Ley D, Duhamel A, Behal H, Vasseur F, Sarter H, Michaud L, Gower-Rousseau C, Turck D. Growth pattern in paediatric Crohn disease is related to inflammatory status. J Pediatr Gastroenterol Nutr 2016; 63: 637-643.
Mandhan P. Sigmoidoscopy in children with chronic lower gastrointestinal bleeding. J Paediatr Child Health 2004; 40: 365-368.
Mougenot J, Baldassarre M, Mashako L, Hanteclair G, Dupont C, Leluyer B. Recto-colic polyps in the child. Analysis of 183 cases. Arch Fr Pediatr 1989; 46: 245-248.
Latt TT, Nicholl R, Domizio P, Walker-Smith JA, Williams CB. Rectal bleeding and polyps. Arch Dis Child 1993; 69: 144-147.
Poddar U, Thapa B, Vaiphei K, Singh K. Colonic polyps: experience of 236 Indian children. Am J Gastroenterol 1998; 93: 619-622.
Hood B, Bigler S, Bishop P, Liu H, Ahmad N, Renault M, Nowicki M. Juvenile polyps and juvenile polyp syndromes in children: a clinical and endoscopic survey. Clin Pediatr (Phila) 2011; 50: 910-915.
Wiseman J, Emil S. Minimal access surgical management of large juvenile polyps in children. J Pediatr Surg 2009; 44: E9- E13.
Mansueto P, Iacono G, Seidita A, D’Alcamo A, Sprini D, Carroccio A. Review article: intestinal lymphoid nodular hyperplasia in children - the relationship to food hypersensitivity. Aliment Pharmacol Ther 2012; 35: 1000-1009.
Lucarelli S, Lastrucci G, Di Nardo G, D’Alfonso Y, Aloi M, Oliva S, Frediani S, Rossetti D, Frediani T. Intestinal lymphoid nodular hyperplasia in children: the relationship to food allergy. Pediatr Allergy Immunol 2015; 26: 18-24.
Dehghani SM, Bahmanyar M, Geramizadeh B, Alizadeh A, Haghighat M. Solitary rectal ulcer syndrome: Is it really a rare condition in children? World Journal of Clinical Pediatrics 2016; 5: 343.
Palle SK, Prasad M, Kugathasan S. Approach to a child with colitis. Indian J Pediatr 2016; 83: 1444-1451.