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
ARTICLE HIGHLIGHTS
Research background

Gastrointestinal bleeding (GIB) is a serious health problem worldwide, particularly in childhood. The incidence, clinical presentation, and causes of pediatric GIB vary among countries.

Research motivation

Due to limited data on GIB in the pediatric population in the Middle East, we were motivated to study this health problem in Bahrain.

Research objectives

To assess the incidence, clinical presentation, causes, and outcomes of GIB in children at the main tertiary hospital in Bahrain over the last two decades and to stratify the causes of GIB according to the patients’ age group.

Research methods

We retrospectively reviewed and collected the demographic data, clinical presentation, endoscopic findings, and outcomes of children with GIB admitted to the Pediatric Department at Salmaniya Medical Complex, Kingdom of Bahrain, from medical records between 1995 and 2022. The causes of GIB were compared according to patient’s age at presentation.

Research results

A total of 250 patients with GIB 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 (IQR, 5–11). Ninety-eight (39.2%) patients required upper gastrointestinal endoscopy alone, 41 (16.4%) required colonoscopy alone, and 111 (44.4%) required both. Lower GIB (LGIB) was more frequent (n = 151, 60.4%) than upper GIB (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. Inflammatory bowel disease (IBD) was the most common cause of LGIB (n = 77, 30.8%), whereas gastritis was the most common cause of UGIB (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), while 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 intervention. The median follow-up period by endoscopy was two years (IQR, 0.5-3). No mortality was reported in this study.

Research conclusions

GIB in children is an alarming condition that is increasing significantly. LGIB were more frequent than UGIB. IBD was the most common cause of LGIB, whereas gastritis was the most common cause of UGIB in our children. The cause for GIB varied based on patient age and differed from those reported in neighboring countries and the rest of the world.

Research perspectives

Further studies are needed that include children with GIB from an emergency setting and studies that assess the effect of this bleeding on patients’ hemodynamic stability, the need for blood transfusion, and the long-term impact of this condition.