To Evaluate the Diagnostic Impact of Gastrointestinal Symptoms in Pediatric Patients with Inflammatory Bowel Disease and Polyp

Year 2021, Volume: 15 Issue: 6, 470 - 475, 26.11.2021

Selim Dereci Tuğba Koca Mustafa Akçam

https://doi.org/10.12956/tchd.800732

Abstract

Objective: To evaluate the diagnostic impact of gastrointestinal symptoms (GIS) in pediatric patients with inflammatory bowel disease and polyps detected by colonoscopy.

Material and Methods: Results of Colonoscopy performed on children younger than 18 years, between 2010 and 2015 in our clinic were retrospectively reviewed. All colonoscopy procedures were performed using a Fujinon EC 530LP IC657K068 video-colonoscope. Data regarding age, gender, indications, complications, and final diagnoses were collected and analyzed.

Results: One hundred and thirty-six children undergoing 121 colonoscopies and 15 sigmoidoscopies were enrolled. Seventy-five patients (55.1%) were boys, with a mean age of 11.8 ± 4.1 years (1-18 years). The most common indication was chronic abdominal pain (42.1%, n=51), followed by lower gastrointestinal bleeding (37.2%, n=45), and chronic diarrhea (10.8%, n=13). Conclusive diagnosis relied on endoscopic imaging and/or histology in 75 (62%) patients, including nonspecific colitis (23.9%, n=29), polyp (19%, n=23), inflammatory bowel disease (IBD) (8.2%, n=10), which had normal (38%, n=56) findings. The sensitivity of the rectal bleeding in predicting the presence of polyp was 86.9%, specificity 74.49%. Chronic diarrhea and iron deficiency IBD predictive sensitivities (40%, 20%, respectively) and positive predictive value (30.77%, 20%, respectively) was low, while specificity (91.89%, 92.79%, respectively) and negative predictive value (94.44%, 92.79%, respectively) was found to be high.

Conclusion: It is very important to diagnose according to GIS symptoms. Rectal bleeding was found to be the most sensitive symptom for polyps. Chronic diarrhea was the most specific symptom in predicting the diagnosis of IBD. In order to make the most accurate diagnosis with colonoscopy in children, GIS symptoms must be taken into consideration.

Keywords

Children, Colonoscopy, Diagnosis, Impact, Inflammatory Bowel Disease, Polyp

İnflamatuvar Bağırsak Hastalığı ve Polipli Çocuk Hastalarda Gastrointestinal Semptomların Tanısal Etkisini Değerlendirmek

Abstract

Amaç: Kolonoskopi işlemi ile inflamatuar bağırsak hastalığı ve polip tespit edilen çocuk hastalarda gastrointestinal semptomların (GIS) tanısal etkisini değerlendirmek.

Gereç ve Yöntemler: Kliniğimizde 2010-2015 yılları arasında 18 yaş altı çocuklara uygulanan kolonoskopi sonuçları geriye dönük olarak incelendi. Tüm kolonoskopi işlemleri Fujinon EC 530LP IC657K068 video kolonoskop kullanılarak gerçekleştirildi. Yaş, cinsiyet, endikasyonlar, komplikasyonlar ve son tanılarla ilgili veriler toplandı ve analiz edildi.

Bulgular: Yüz otuz altı çocuğa 121 kolonoskopi ve 15 sigmoidoskopi işlemi yapıldı. Yetmiş beş hasta (% 55.1) erkek ve yaş ortalaması 11.8±4.1 yıl (1-18 yıl)’dı. En yaygın endikasyon kronik karın ağrısı (% 42.1, n=51), ardından alt gastrointestinal kanama (% 37.2, n=45) ve kronik ishal (% 10.8, n=13)’dü. Endoskopik görüntüleme ve / veya histoloji sonuçlarına göre 75 (% 62) hastaya spesifik olmayan kolit (% 23.9, n=29), polip (% 19, n=23), enflamatuar bağırsak hastalığı (IBH) (% 8.2, n=10) tanıları konuldu ve 56 (%38)hasta normal olarak değerlendirildi. Rektal kanama polip varlığını öngörmede % 86.9 duyarlı, % 74.49 özgüldü. IBH belirlemede kronik ishal ve demir eksikliğinin duyarlılıkları (sırasıyla % 40, % 20) ve pozitif prediktif değeri (sırasıyla % 30.77, % 20) düşük, özgüllüğü (sırasıyla % 91.89, % 92.79) ve negatif prediktif değeri (sırasıyla %94.4, % 92.79) yüksek bulundu.

Sonuç: Gastrointestinal semptomlar doğrultusunda tanı koymak çok önemlidir. Rektal kanama poliplerin tespitinde en hassas semptom olarak değerlendirildi. Inflamatuvar barsak hastalığı tanısını öngörmede en spesifik semptom kronik ishaldı. Çocuklarda kolonoskopi ile doğru tanı konulabilmesi için GİS semptomlarının dikkate değerlendirilmesi gereklidir.

Keywords

Çocuk, Kolonoskopi, Tanı, Etki, İnflamatuar Bağırsak Hastalığı, Polip

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