Çocuk Acil Kliniğine Gelen Gastrointestinal Kanamalı 47 Olgunun Retrospektif Değerlendirilmesi

Year 2017, , 197 - 204, 04.01.2018

Esra Türe , Abdullah Yazar , Fatih Akın

https://doi.org/10.31832/smj.359943

Cited By: 1

Abstract

Amaç: Gastrointestinal sistem kanaması çocukluk
çağında her yaşta karşımıza çıkabilen ve ağızdan anüse kadar her yerinde
görülebilen önemli bir çocuk acil sorunudur. Bu çalışmada çocuk acil
kliniğimize gastrointestinal kanama ile başvuran hastaların epidemiyolojik ve
laboratuvar özelliklerini ve kanamanın etiyolojik nedenlerini araştırmayı
amaçladık.

 Gereç ve Yöntem: Çocuk Acil kliniğine
başvuran, gastrointestinal kanama tanısı almış 18 yaş altı hastaların,
kayıtları ve yatış dosyaları retrospektif olarak incelendi. Hastaların yaş,
cinsiyet, geliş yakınmaları, kullandığı ilaçlar, laboratuvar bulguları,
aldıkları tanılar, tedavi yöntemleri, endoskopi ve kolonoskopi bulguları
incelendi.

Bulgular: Çocuk acil kliniğine son bir yılda başvuran
hastaların 47’si gastrointestinal kanama tanısı aldı. Bunların 24’ü (%51,1)
üst, 23’ü (%48,9) alt gastrointestinal kanama idi. Hastaların %40,4’ünde (n:
19) hematemez, %14,9’unda (n: 7) melena ve %44,7’sinde (n:21) hematokezya
tespit edildi. Melena ile başvuranların istatistiksel anlamlı olarak (p:0,02)
en fazla 5 yaş altında (n:4, %57,1) olduğu görüldü. Hastaların 20’sinde (%42,6)
ilaç kullanım hikayesi mevcuttu. İlaç kullanım hikayesi olan 20 hastanın 18’nin
(%90) istatistiksel anlamlı olarak non-steroid anti-inflamatuar ilaç kullandığı
tespit edildi. Helicobacter pylori pozitif tespit edilen 12 hastanın 6’sı (%50)
istatistiksel anlamlı olarak gastrit tanısı aldı. Helicobacter pylori pozitif
tespit edilen 12 hastanın 6’sının (%50) istatistiksel anlamlı olarak hematemez
ile başvurduğu görüldü.

Sonuç: Bu çalışmada gastrit ve peptik ülserin
gastrointestinal kanamanın en sık nedenleri olduğu görüldü. Gastrointestinal
kanamaları risk faktörlerine göre değerlendirildiği zaman non-steroid
anti-inflamatuar kullanımı ve Helicobacter pylori enfeksiyonunun mukozal
lezyonlar ile ilişkisi ortaya koyuldu. Bu nedenle hastaların çocuk acil
kliniklerinde özenle değerlendirilip yakın izleme alınması aynı zamanda hasta
yakınlarının akılcı ilaç kullanımı konusunda bilgilendirilmesi gerekmektedir.

Keywords

Gastrointestinal sistem; kanama; çocuk acil

Retrospective Evaluation Of 47 Patients With Gastrointestinal Bleeding In Pediatric Emergency Clinic

Abstract

Objective:
Gastrointestinal bleeding (GB) is an important emergency problem that can be
seen at any age and every part of gastrointestinal system from mouth to anus.
In this study, we aimed to investigate demographic, epidemiologic, clinical and
laboratory characteristics of patients with GB who admitted to emergency
department.

Material and Method: The
records of patients <18 years who admitted to pediatric emergency department
with GB were reviewed retrospectively. The age, gender, complaints, drug
history, laboratory findings, diagnoses, treatment modalities, endoscopy and
colonoscopy findings were recorded.

Results: 47
were found to be folllowed up with the diagnosis of GB in our department. 24
(51.1%) of these were upper and 23 (48.9%) lower GB. Hematemesis was detected
in 40.4% (n:19), melena in 14.9% (n:7) and hematochezia in 44.7% (n:21) of
them. Patients who applied with melena were mostly <5 years (n:4, 57.1%)
which was statistically significant.  Twenty
of the patients (42.6%) had drug usage history. 18 (90%) were found to use
non-steroidal anti-inflammatory drugs. 6 of the 12 Helicobacter pylori positive
(50%) patients were diagnosed as gastritis with statistical significance. 6
patients (50%) with positive Helicobacter pylori were found to have a
statistically significant complaint of hematemesis.

Conclusion: In
this study, gastritis and peptic ulcer were the most common causes of GB. The
assessment of GB according to risk factors, revealed that, non-steroidal
anti-inflammatory drug usage and Helicobacter pylori infection were associated
with mucosal lesions. Therefore, patients admitted to pediatric emergency
departments should be evaluated carefully and informed about rational drug
usage.

Keywords

Gastrointestinal system; bleeding; child emergency

References

• Referans 1. Wyllie R, Hyams JS, Kay M. Gastrointestinal Hemorrhage. In: Sahn B, Namula P, Friedlander J (Editors). Pediatric gastrointestinal and liver disease. 5th ed. Philadelphia: Elsevier Health Sciences; 2015. 144-154 Referans 2. Treem W. Gastrointestinal bleeding in children. Gastrointestinal endoscopy clinics of North America. 1994; 4: 75-97.
• Referans 3. Bachur R, Shaw K. Fleisher & Ludwig's Textbook of Pediatric Emergency Medicine. 7th ed. Philadelphia: Wolters Kluwer;. 2015. 193-202
• Referans 4. Rodgers BM. Upper gastrointestinal hemorrhage. Pediatr Rev. 1999; 20 :171-174.
• Referans 5. Grimaldi-Bensouda L, Abenhaim L, Michaud L, et al. Clinical features and risk factors for upper gastrointestinal bleeding in children: a case-crossover study. Eur J Clin Pharmacol. 2010; 66: 831-837.
• Referans 6. Teach SJ, Fleisher GR. Rectal bleeding in the pediatric emergency department. Ann Emerg Med. 1994; 23: 1252-1258.
• Referans 7. Pant C, Olyaee M, Sferra TJ, Gilroy R, Almadhoun O, Deshpande A. Emergency department visits for gastrointestinal bleeding in children: results from the Nationwide Emergency Department Sample 2006–2011. Curr Med Res Opin. 2015; 31: 347-351.
• Referans 8. Cox K, Ament ME. Upper gastrointestinal bleeding in children and adolescents. Pediatrics. 1979; 63: 408-413.
• Referans 9. Yachha S, Khanduri A, Sharma B, Kumar M. Gastrointestinal bleeding in children. J Gastroenterol Hepatol 1996; 11: 903-907.
• Referans 10. Pongprasobchai S, Nimitvilai S, Chasawat J, Manatsathit S. Upper gastrointestinal bleeding etiology score for predicting variceal and non-variceal bleeding. World J Gastroenterol. 2009; 15: 1099-1104.
• Referans 11. Barnert J, Messmann H. Management of lower gastrointestinal tract bleeding. Best Pract Res Clin Gastroenterol. 2008; 22: 295-312.
• Referans 12. Dehghani SM, Haghighat M, Imanieh MH, Tabebordbar MR. Upper gastrointestinal bleeding in children in Southern Iran. Indian J Pediatr. 2009; 76: 635-638.
• Referans 13. Lanza FL, Chan FK, Quigley EM. Practice Parameters Committee of the American College of Gastroenterology. Guidelines for prevention of NSAID-related ulcer complications. Am J Gastroenterol. 2009; 104: 728-738.
• Referans 14. Singh G. Gastrointestinal complications of prescription and over the-counter nonsteroidal anti-inflammatory drugs: a view from the ARAMIS database. Arthritis, Rheumatism, and Aging Medical Information System. Am J Ther. 2000; 7: 115-121.
• Referans 15. Matsui H, Shimokawa O, Kaneko T, Nagano Y, Rai K, Hyodo I. The pathophysiology of non-steroidal anti-inflammatory drug (NSAID)-induced mucosal injuries in stomach and small intestine. J. Clin Biochem. Nutr. 2011; 48: 107-111.
• Referans 16. Cardile S, Martinelli M, Barabino A, et al. Italian survey on non-steroidal anti-inflammatory drugs and gastrointestinal bleeding in children. World J Gastroenterol. 2016; 22: 1877-1883.
• Referans 17. Dolatkhah R, Khoshbaten M, Asvadi Kermani I, et al. Upper gastrointestinal bleedings in patients with hereditary coagulation disorders in Northwest of Iran: prevalence of Helicobacter pylori infection. Eur J Gastroenterol Hepatol. 2011; 23: 1172-1177.
• Referans 18. Boukthir S, Mazigh SM, Kaach N, Bouyahya O, Sammoud A. The effect of non-steroidal anti-inflammatory drugs and Helicobacter pylori infection on the gastric mucosa in children with upper gastrointestinal bleeding. Pediatr Surg Int. 2010; 26: 227-230.
• Referans 19. Bahú MdGS, da Silveira TR, Maguilnick I, Ulbrich-Kulczynski J. Endoscopic nodular gastritis: an endoscopic indicator of high-grade bacterial colonization and severe gastritis in children with Helicobacter pylori. J Pediatr Gastroenterol Nutr. 2003; 36: 217-222.
• Referans 20. Lehmann CU, Elitsur Y. Juvenile polyps and their distribution in pediatric patients with gastrointestinal bleeding. W V Med J. 1996; 92: 133-135.