Üst veya alt gastrointestinal kanama ile başvuran çocuk hastaların değerlendirilmesi
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Date
2014
Authors
Altay, Derya
Journal Title
Journal ISSN
Volume Title
Publisher
Uludağ Üniversitesi
Abstract
Gastrointestinal kanamalar her yaş çocukta görülebilen ve pediatrik gastroenterologlara sık başvuru nedenlerinden biridir. Yaş gruplarına göre nedenleri değişmekle birlikte kanamanın şiddeti ile orantılı olarak beraberinde hayati risk taşırlar. Bu çalışmada kliniğimize gastrointestinal kanama yakınmasıyla başvuran hastalarda demografik ve etyolojik faktörlerin saptanması amaçlandı. Çalışmaya Ocak 2010-Nisan 2014 tarihleri arasında Uludağ Üniversitesi Tıp Fakültesi Çocuk Gastroenteroloji Bölümü'ne üst veya alt gastrointestinal kanama yakınmasıyla başvuran toplam 150 hasta alındı. Hasta dosyaları retrospektif olarak değerlendirildi. Gastrointestinal kanama yakınmasıyla başvuran 63 (%42) kız ve 87 (%58) erkek olmak üzere 150 hasta çalışmaya alındı. Başvuru anında hastaların yaş ortalaması 11+4.6 yıl idi. Etyolojide üst gastrointestinal kanamalı olguların %24.7'sinde H.pylori pozitif saptanmış olup, H.pylori pozitif olguların %80'i 10 yaşından büyük idi. Peptik ülser saptanan 20 olgunun 14'ü (%70) 10 yaşından büyük grupta idi. 8 (%5.3) hastada özofageal varis saptandı. 23 (%15.3) hastanın kanama öncesinde ilaç kullanım öyküsü vardı. Bunların da %52.1'i nonsteroidal antinflamatuar ilaç kullanmıştı. Alt gastrointestinal kanaması olan 20 (%25) olguya ülseratif kolit, 4 (%5) olguya Crohn hastalığı tanısı konmuş olup, 10 (%12.5) olguda kolonda polip saptandı. Poliplerin %90'ı rektosigmoid kolonda lokalize idi. Alt gastrointestinal kanamalı 23 (%28.7) hastanın kolonoskopisi normal idi. Üst gastrointestinal kanamalı olguların büyük çoğunluğunda etyolojide peptik ülser saptanmış olup, alt gastrointestinal kanamalı olguların çoğunluğu inflamatuar barsak hastalığı tanısı almıştı. Prognozda kanama nedeniyle eksitus saptanmamıştır. Çocuklarda gastrointestinal kanama, tersiyer bir merkeze sevkin önemli nedenlerinden biridir. Toplumumuzda H.pylori enfeksiyonu sıklığı göz önünde bulundurulursa üst gastrointestinal kanamalı olgularımızın %24.7'sinde pozitiflik bulunmuştur. Alt gastrointestinal kanamalı olgularda büyük çoğunluğu idiopatik olmakla birlikte ülseratif kolit önemli bir yer tutmaktadır.
Gastrointestinal bleeding can be seen in children of all ages and it is one of the most frequent application reason to pediatric gastroenterologists. Even though the causes of bleeding differs according to age groups, it may become life-threatening depending on the severity of the bleeding. The aim of the study was to determine the demographical and etiological factors of patients who admitted to our clinic with upper or lower gastrointestinal bleeding. 150 patients, were included to the study, admitted to Uludag University Faculty of Medicine Pediatric Gastroenterology department with upper or lower gastrointestinal bleeding between January 2010 and April 2014. The study included 63 (42%) girls and 87 (58%) boys. The mean age of the patients were 11±4.6 years. At the etiology of these upper gastrointestinal bleeding cases H.pylori were detected in 24.7%, and 80% of the patients with H.pylori positive were older than 10 years. 14 (70%) of 20 patients with peptic ulcer disease were in the group of older than 10 years. Esophageal varices were detected in 8 (5.3%) patients with gastrointestinal bleeding. 23 (15.3%) patients had a history of drug use prior to bleeding. 52.1% of those had used nonsteroidal anti-inflammatory drugs. 20 (25%) patients with gastrointestinal bleeding were diagnosed as ulcerative colitis, and 4 (5%) patients were diagnosed as Crohn disease, 10 (12.5%) cases were detected polyps in the colon. 90% of polyps were localised in rectosigmoid colon. Colonoscopy was normal in 23 (28.7%) patients with lower gastrointestinal bleeding. Peptic ulcer disease was detected majority in etiology of the patients with upper gastrointestinal bleeding and majority of the cases with lower gastrointestinal bleeding were diagnosed as inflammatory bowel disase. All cases were evaluated, there were no death because of bleeding at the prognosis of these patients. Gastrointestinal bleeding is one of important reason for reference of tertiary center in children. Considering the frequency of H.pylori positivity in our society, 24.7% were found to be positive in cases with upper gastrointestinal bleeding. Although the vast majority of patients with lower gastrointestinal bleeding were idiopatic, ulcerative colitis plays an important role in patients with lower gastrointestinal bleeding.
Gastrointestinal bleeding can be seen in children of all ages and it is one of the most frequent application reason to pediatric gastroenterologists. Even though the causes of bleeding differs according to age groups, it may become life-threatening depending on the severity of the bleeding. The aim of the study was to determine the demographical and etiological factors of patients who admitted to our clinic with upper or lower gastrointestinal bleeding. 150 patients, were included to the study, admitted to Uludag University Faculty of Medicine Pediatric Gastroenterology department with upper or lower gastrointestinal bleeding between January 2010 and April 2014. The study included 63 (42%) girls and 87 (58%) boys. The mean age of the patients were 11±4.6 years. At the etiology of these upper gastrointestinal bleeding cases H.pylori were detected in 24.7%, and 80% of the patients with H.pylori positive were older than 10 years. 14 (70%) of 20 patients with peptic ulcer disease were in the group of older than 10 years. Esophageal varices were detected in 8 (5.3%) patients with gastrointestinal bleeding. 23 (15.3%) patients had a history of drug use prior to bleeding. 52.1% of those had used nonsteroidal anti-inflammatory drugs. 20 (25%) patients with gastrointestinal bleeding were diagnosed as ulcerative colitis, and 4 (5%) patients were diagnosed as Crohn disease, 10 (12.5%) cases were detected polyps in the colon. 90% of polyps were localised in rectosigmoid colon. Colonoscopy was normal in 23 (28.7%) patients with lower gastrointestinal bleeding. Peptic ulcer disease was detected majority in etiology of the patients with upper gastrointestinal bleeding and majority of the cases with lower gastrointestinal bleeding were diagnosed as inflammatory bowel disase. All cases were evaluated, there were no death because of bleeding at the prognosis of these patients. Gastrointestinal bleeding is one of important reason for reference of tertiary center in children. Considering the frequency of H.pylori positivity in our society, 24.7% were found to be positive in cases with upper gastrointestinal bleeding. Although the vast majority of patients with lower gastrointestinal bleeding were idiopatic, ulcerative colitis plays an important role in patients with lower gastrointestinal bleeding.
Description
Keywords
Çocuk, Gastrointestinal kanama, Children, Gastrointestinal bleeding
Citation
Altay, D. (2014). Üst veya alt gastrointestinal kanama ile başvuran çocuk hastaların değerlendirilmesi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.