To determine etiology and outcome of children with lower gastrointestinal bleeding (LGIB).
This was a prospective study conducted at the Department of Pediatric Gastroenterology and Hepatology, ...Children's Hospital and The Institute of Child's Heath, Multan, Pakistan, from July 2019 to March 2020. A total of 148 cases presented with bleeding per rectum and underwent colonoscopy, were included. Children of both genders and aged three month to 15 years were included. Detailed history, clinical examination, laboratory studies, colonoscopy and histopathology were done in all cases. Study information like demographics, complaints, general clinical examination, colonoscopy and histopathological findings were recorded.
Overall, mean age was noted to be 7.20±1.83 years. Abdominal pain was reported in 41 (27.7%), diarrhea 36 (24.3%), fever 12 (8.1%) and constipation in 4 (2.7%). Pallor was noted among 68 (45.9%), weight loss 39 (26.3%) and tachycardia 31 (20.9%). Colonoscopy revealed juvenile colonic / rectal polyps, infectious colitis and solitary rectal ulcer (SRU) as the most common etiologies found among 58 (39.2%), 20 (13.5%) and 19 (12.8%) cases respectively. Juvenile polyps and non-specific colitis were the commonest histopathological findings seen in 55 (37.2%) and 20 (13.5%) cases respectively. Colonoscopic polypectomy was used to remove all juvenile polyps.
LGIB is presentation of various underlying causes. Children with LGIB commonly present with abdominal pain. Juvenile polyps were the most frequent cause of LGIB among children flowed by non-specific colitis. Most of the children having LGIB were diagnosed and treated successfully, few are in remission and very few were found resistant to treatment.
OBJECTIVES: To find out the etiology and outcome in terms of clinical improvement among children having esophageal stricture (ES). METHODS: This prospective study was conducted from July 2019 to ...March 2020 at Children’s Hospital, Multan, Pakistan on diagnosed patients of ES, ageing <15 years. Demographic details, different etiologies, location of the ES and treatment outcome were recorded. After initial management, endoscopy and dilatation was done at 6 weeks. Patients were followed-up for at least 12 weeks. RESULTS: Out of 32 children with ES, 19 (59.4%) were males. Mean age of children was 36.58±19.6 months. Twenty-four (75%) patients had proximal and 8 (25%) had distal stricture. Chemical burn (n=23; 71.9%) and esophageal atresia (n=4: 12.5%) were commonest causes of ES. Dilatation and surgery were performed in 21 (65.6%) cases followed by dilatation only in 10 (31.3%) cases and surgery alone in one (3.1%) case. In patients with chemical burns, majority (n=16/23; 69.6%) required both dilatation and surgery. Overall outcome of treatment options was good in 62.5% (n=20/32) patients. Outcome was good in 61.9% (n=13/21) of patients requiring both dilatation and surgery and 70% (n=7/10) in patients having dilatation alone (p=0.385). Outcome was good in 69.6% (n=16/23) of patients with chemical burns and 70% (n=7/10) in patients with dilatation only (p=0.385). Mortality rate was 3.1% (n=1). CONCLUSION: Chemical burn and esophageal atresia were the commonest causes of ES. Outcome of all procedures was good in 62.5% cases and had no significant relationship with causes and site of ES or types of treatment.
OBJECTIVE: To find out various hematological manifestations among children from South Punjab, having confirmed celiac disease (CD). METHODS: This case-control study was done at The Institute of ...Child Health, Multan, Pakistan, from 1st February 2019 to 31st July 2019. We enrolled 139 children having CD, ranging in age from 1-12 years. An equal number of age and gender matched controls were also enrolled. Haematological parameters were compared between cases and controls. RESULTS: Majority (n=83/139; 59.7%) of children with CD were male. Mean age was 8.78±2.4 years. The common hematological manifestations among children with CD were anemia (n=127; 91.4%), thrombocytosis (n=104; 74.8%); leucopenia (n=10; 7.2%) and coagulopathy (n=13; 9.4%). Anemia alone was present in 20 (14.4%) children, anemia plus thrombocytosis in 91 (65.5%) cases, anemia plus leucopenia in 7 (5.0%) cases and anemia along with thrombocytosis and coagulopathy in 9 (6.5%) cases. Out of 127 cases of anemia, iron deficiency anemia (IDA) was noted in 96 (75.6%) cases, vitamin B12 and folate deficiency anemia in 14 (10.1%) cases whereas double deficiency anemia was seen in 17 (13.4%) cases. According to Modified Marsh Scoring, majority (n=46; 33.1%) of children had Type 3a CD. When compared to controls, CD cases had significantly lower haemoglobin, raised platelet count, lower mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH) levels (p value<0.0001). CONCLUSION: In children having CD, hematological manifestations are common. IDA is the most frequent hematological abnormality observed along with thrombocytosis in children with CD. Hematological parameters were significantly impaired among children with CD.
Objective: To evaluate the effectiveness of adding hydrocortisone enema in the traditional management of Solitary rectal ulcers (SRU) in pediatric patients. Study Design: Randomized Controlled Trial. ...Setting: Department of Pediatric Gastroenterology, Children’s Hospital and The Institute of Child’s Heath, Multan, Pakistan. Period: January, 2021 till December, 2021. Material & Methods: A total of 52 children (15 years or younger) diagnosed to have SRU were included. Demographic data, clinical and colonoscopic findings were collected. Children were randomly divided into two groups. Group-A received only conventional therapy while Group-B received hydrocortisone enema in addition to conventional therapy. After starting treatment, patients were followed up every 15 days up to duration of 6 months and response to the treatment in terms of complete resolution of symptoms was noted. Results: The Mean age of 52 children was 9 + 1.8 years. Twenty eight (53.8%) were boys. The mean duration of symptoms was 5 + 1.4 months. Most common presenting features were per-rectal bleed 48 (92.3%) and mucus in stool 27 (51.9%). It was found that 14/25 (56.0%) children in Group-A reported complete resolution of symptoms in comparison to 20/24 (83.3%) in Group-B (p=0.0380) at 2-months post treatment follow up. Forty one children completed the 6-months follow up period and included in the final analysis. It was found that 10/21 (47.6%) children reported completed resolution of symptoms while Group-B, 18/20 (90.0%) children had complete resolution of symptoms (p=0.0036) at 6-months follow up. Conclusion: In children with SRUS, hydrocortisone enemas along with conventional treatment were found to be significantly more useful in resolution of pretreatment symptoms in comparison to conventional treatment alone. Further studies involving large sets of population are needed to verify the findings of present study.
Objective: To determine the frequency of psychosocial impairment in patients with celiac disease. Study Design: Descriptive Cross Sectional study. Setting: Children Hospital Complex and Institute of ...Child Health, (CHICH) Multan. Period: August 2019 to August 2020. Material & Methods: A total number of 177 patients having age 4-16 years with diagnosis of CD were included in this study. In children with CD depressive illness were assessed by using Pediatric symptoms checklist (PSC) form and this PSC form was filled by asking questions from parents then filling of form by doctor. Outcome variable was calculated on the basis of Pediatric symptoms checklist (PSC), whether patient has psychosocial illness or not. Results: Mean age of patients was 8.91±3.50 years. Mean duration of celiac disease of patients was 4.27±2.00 months. There were 135 (76.27%) female patients and 42 (23.73%) male patients. Mean serum anti-tissue transglutaminase IgA (tTG-IgA) level of patients was 122.73±24.31 µg/ml. The socioeconomic status of 115 (64.97%) patients was poor, 31 (17.51%) was middle, 18 (10.17%) patient was upper middle and 13 (7.34%) patients was high. Psychosocial illness was present in 35 (19.77%) patients. Conclusion: Psychosocial illness was diagnosed in 19.77% children having CD. So the children with celiac disease should be monitored for symptoms of anxiety and depression and a thorough counselling of the children to reduce the risk of psychosocial illness.
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