Comparison of injection sclerotherapy only for bleeding esophageal varices and injection sclerotherapy with somatostatin analogue infusion: randomized prospective study with 2 years follow-up in children

Portal hypertension is a pathological rise of portal blood pressure above 10 mmHg with subsequent development of portosystemic collaterals including esophageal varices. Variceal hemorrhage may cause significant morbidity and mortality in children with cirrhosis and rational for upper Endoscopy. Besides the general hemodynamic resuscitation, Octerotide was used to control acute bleeding with success. Endoscopic sclerotherapy arrests hemorrhage in 80% to 90% of cases, however, with 0.5% to 2% mortality. To evaluate the difference between treating first time bleeding varices in children with Endoscopic sclerotherapy alone or combined with Somatostatrn analogue, Octerotide, we designated this random, prospective study and 2 year follow-up. Forty children were enrolled, 30 male and 10 females. Children were randomly divided into 2 groups: Group I consists of 20 children with first time bleeding esophageal varices who were treated by injection sclerotherapy only and Group II consists of simlar 20 children whom bleeding was managed by sclerotherapy and Octerotide. The sample was homogenous as regard the clinical presentations and examination except for hepatomegaly which was seen in 7 [35%] in group I and in 13 [65%] in group II. Portal vein thrombosis, Bilharzial fibrosis and post-hepatitic cirrhosis represented the most frequent etiology with 13 [32.5%], 9 [22.5%] and 7 [17.5%] order of detection. Endoscopic appearance at the time of first bleeding revealed predominance of grade II varices. It was seen in 12 [60%] in group I and 10 [50%] in group II. Two years later majority of group I varices were grade I, while majority of group II varices were grade II [0 [55%] and 11 [70%] respectively]. Portal hypertensive gastropathy were absent in 12 [61%] in group I and in II [70%] in group II after 2 years follow-up. Endoscopy and Octerotide related complications were seldom in this study. We concluded that Injection sclerotherapy remains the standard of care, combining Octerotide can improve the control of acute bleeding and early rebleeding however, its high cost renders its use rather limited

Rectal sparing in children with ulcerative colitis at the time of diagnosis: one centre experience

Ulcerative colitis classically presents with confluent and diffuse proctitis, whereas rectal sparing may be seen in the large intestinal presentation of Crohn's disease. Rectal sparing in ulcerative colitis was reported in a few studies as an indicator of more severe form of the disease. The aim of this study is to assess the incidence and the prognostic value of rectal spring in children with newly diagnosed ulcerative colitis before starting treatment. The records of children with untreated ulcerative colitis presenting to Bristol royal for sick children-UK [tertiary referral centre for Pediatric gastroenterology] were retrospectively reviewed between June 2003 and December 2004, then followed up for one year. Patients were subdivided according to the endoscopic appearance of the rectum into two groups; group I with proctitis and group 2 with rectal sparing, Complete clinical examination, blood tests, intractability index [defined as duration of active disease as a proportion of length of follow up], response to treatment, relapse index[defines as number of recurrences per year] and the need for surgery were studied and statistically analysed. 18 Patients with untreated ulcerative colitis were identified. 4[22%] had rectal sparing at the initial endoscopic examination. Rather than the rectal involvement, disease distribution was nearly similar in both groups. Presenting symptoms were almost the same in both groups. In group 1, 12[85%] children achieved remission with initial medical treatment, compared with 3 [75%]in group 2[p=0.08]. The intractability index was higher in children with rectal sparing but the difference was not statistically significant [P=0.22]. During one year follow up. One [25%] child in group 2 experienced primary sclerosing cholangitis and one [25%]. Child in group 2 required subtotal colectomy, compared with none in group 1. We concluded that rectal sparing was diagnosed in 22%of newly diagnosed, untreated ulcerative colitis in children. This feature did not correlate with presenting symptoms. However, the presence of rectal sparing may indicate more aggressive disease that is less responsive to medical treatment