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

Öz

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.

Anahtar Kelimeler

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

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

Öz

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.

Anahtar Kelimeler

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

Kaynakça

1. 1. Thakkar K, Holub JL, Gilger MA, Shub MD, McOmber M, Tsou M, et al. DS.Quality indicators for pediatric colonoscopy: results from a multicenter consortium. Gastrointest Endosc 2016; 83:533-41.
2. 2. Park JH. Pediatric Colonoscopy: The Changing Patterns and Single Institutional Experience Over a Decade. Clin Endosc 2018;51:137-41.
3. 3. Wu CT, Chen CA, Yang YJ. Characteristics and Diagnostic Yield of Pediatric Colonoscopy in Taiwan. Pediatr Neonatol 2015; 56:334-38.
4. 4. Jae Hong Park. Role of colonoscopy in the diagnosis and treatmentof pediatric lower gastrointestinal disorders. Korean J Pediatr 2010; 53:824-29.
5. 5. Tam YH, Lee KH, Chan KW, Sihoe JD, Cheung ST, Mou JW. Colonoscopy in Hong Kong Chinese children. World J Gastroenterol 2010;16: 1119-92.
6. 6. Wahid AM, Devarajan K, Ross A, Zilbauer M, Heuschkel R. Paediatric gastrointestinal endoscopy: a qualitative study. Eur J Gastroenterol Hepatol 2016;28:25-29.
7. 7. Victor LF. Colonoscopy. In: Walker WA, Durie PR, Hamilton JR, Walker-Smith JA, Watkins JB (eds). Pediatric gastrointestinal disease. Pathophysiology, diagnosis, management. 2nd ed. St. Louis: Mosby, 1996;1533-1541.
8. 8. Thomson M. Colonoscopy and enteroscopy. Gastrointest Endosc Clin N Am 2001; 11:603-39.

9. 9. Dahshan A, Lin CH, Peters J, Thomas R, Tolia V. A randomized, prospective study to evaluate the efficacy and acceptance of three bowel preparations for colonoscopy in children. Am J Gastroenterol 1999;94:3497-01.
10. 10. Gilger MA, Gold BD. Pediatric endoscopy: new information from the PEDS-CORI project. Curr Gastroenterol Rep 2005;7:234-39.
11. 11. de Ridder L, van Lingen AV, Taminiau JA, Benninga MA. Rectal bleeding in children: endoscopic evaluation revisited. Eur J Gastroenterol Hepatol 2007;19:317-20.
12. 12. Tam PK, Saing H. Pediatric surgeons can and should perform colonoscopy. J Pediatr Surg 1987;22:332-34.
13. 13. Lindberg E, Lindquist B, Holmquist L, Hildebrand H. Inflammatory bowel disease in children and adolescents in Sweden, 1984-1995. J Pediatr Gastroenterol Nutr 2000;30:259-64.
14. 14. Bowles CJ, Leicester R, Romaya C, Swarbrick E, Williams CB, Epstein O. A prospective study of colonoscopy practice in the UK today: are we adequately prepared for national colorectal cancer screening tomorrow? Gut 2004;53:277-83.
15. 15. Poddar U, Thapa BR, Vaiphei K, Singh K. Colonic polyps: experience of 236 Indian children. Am J Gastroenterol 1998;93:619-22.
16. 16. Jalihal A, Misra SP, Arvind AS, Singh K. Colonoscopic polypectomy in children. J Pediatr Surg 1992;27:1220-22.
17. 17. Gupta SK, Fitzgerald JF, Croffie JM, Chong SK, Pfefferkorn MC, Davis MM, et al. Experience with juvenile polyps in North American children: the need for pancolonoscopy. Am J Gastroenterol 2001;96:1695-97.
18. 18. Barton JR, Gillon S, Ferguson A. Incidence of inflammatory bowel disease in Scottish children between 1968 and 1983; marginal fall in ulcerative colitis, three-fold rise in Crohn's disease. Gut 1989;30:618-22.
19. 19. Armitage E, Drummond H, Ghosh S, Ferguson A. Incidence of juvenile-onset Crohn's disease in Scotland. Lancet 1999;353:1496-97.
20. 20. Cosgrove M, Al-Atia RF, Jenkins HR. The epidemiology of paediatric inflammatory bowel disease. Arch Dis Child 1996;74:460-61.
21. 21. Sawczenko A, Sandhu BK, Logan RF, Jenkins H, Taylor CJ, Mian S, et al. Prospective survey of childhood inflammatory bowel disease in the British Isles. Lancet 2001; 357:1093-94.
22. 22. Kugathasan S, Judd RH, Hoffmann RG, Heikenen J, Telega G, Khan F, et al. Epidemiologic and clinical characteristics of children with newly diagnosed inflammatory bowel disease in Wisconsin: a statewide population-based study. J Pediatr 2003;143:525-31.
23. 23. Peytremann-Bridevaux I, Arditi C, Froehlich F, O'Malley J, Fairclough P, Le Moine O, et al. Appropriateness of colonoscopy in Europe (EPAGE II). Iron-deficiency anemia and hematochezia. Endoscopy 2009;4:227-33.