ABSTRACT
Gastrointestinal disorders in children represent a broad spectrum of acute and chronic conditions including congenital, infectious, inflammatory metabolic and rarely neoplastic disorders. The development of endoscopic instruments to evaluate different parts of the gastrointestinal tract improved significantly the information about diseases affecting the gastrointestinal tract and its management. The addition of endoscopic examination to the investigations of gastrointestinal disorders in children has greatly transformed the practice of pediatric gastroenterology. The present study included 197 children referred for endoscopic examination during the period of October 2002 to September 2005, aged from 3 months to 16 years [average 5.7 years] and 55% of them were males. Referral to the pediatric endoscopy unit was a part of investigating various gastrointestinal disorders. One hundred thirty two patients [67%] were referred for upper gastrointestinal endoscopy while 65 patients [33%] for lower endoscopy. The results showed that, out of 50 patients who presented with [UGIB, 34% had esophago gastric varices: 32% were esophageal and 2% fundal varices. Injection sclerotherapy was done successfully for 5 patients with varices. The second common endoscopic finding in patients with UGIB was erosive and/or hemorrhagic gastritis [28%] followed by duodenitis [8%] and esophagitis [6%]. A combination of esophago-gastro-duodenitis was detected in 6% of the patients. Out of the 30 patients presenting with unexplained vomiting gastritis was the most common endoscopic and histological findings followed by esophagitis and duodenitis. In patients with suspected malabsorption, upper endoscopy revealed pale mucosa in 32% and edematous mucosa in 28% of the cases. In 40% of the cases, no abnormalities could be found. Biopsy examination revealed villous atrophy in 64% and a picture compatible with Crohn's disease in 28%. However, in 8%, no histological abnormality was detected. In patients with unexplained recurrent abdominal pain, UGIE revealed abnormalities in 55% [30% gastritis, 15% duodenitis, and 10% duodenal ulcer]. However, in 45% no abnormality could be detected. Histological abnormalities were found in 90% of cases; 45% active gastritis and Helicobacter pylori [HP] organisms in the antral region, 30% active gastritis without HP and 15% active duodenitis with the HP in the antral region. Collectively, HP organisms were detected in 60% of cases with unexplained RAP. Esophagitis was detected endoscopically and histologically in all cases with dysphagia. In two cases, impacted foreign bodies [a coin and a hair pin] were detected and removed successfully during the same endoscopic examination. Bleeding per rectum was the most frequent cause to do colonoscopy in children. Endoscopically, polyps were the most common detected abnormality [47.37%] followed by colonic inflammation [31.58%]. Histologically, benign juvenile polyps were the most common [28.95%] followed by bilharzial polyps [18.42%], nonspecific colitis [15.79%] and lastly allergic colitis [15.79%]. Endoscopic examination of children with bloody diarrhea revealed various lesions including erythema, edema, mucosal ulceration and/or white exudate in the rectum and colon in 86.67% of the cases. Biopsy examination showed a picture of pseudo-membranous colitis in 53.33%, and ulcerative colitis in 13.33%. In 12 patients with unexplained lower abdominal pain, endoscopy revealed erythema, erosions and minute ulcers in 4 of them while biopsy examination revealed nonspecific proctocolitis in 8 cases. Pediatric gastrointestinal endoscopy is a valuable and informative diagnostic procedure and can be performed safely with the use of intravenous sedation. Therapeutic maneuvers can be also applied as foreign body removal, sclerotherapy and polypectomy. Gastrointestinal bleeding is the commonest indication for endoscopic examination in children. Variceal bleeding represents the major cause of upper gastrointestinal bleeding while colonic polyps are the commonest cause of lower gastrointestinal hemorrhage. Helicobacter pylori infection is increasingly recognized in children and needs further studies to identify its relations to different gastrointestinal complaints in such children. Antibiotics induced diarrhea and pseudo-membranous colitis represent a problem in pediatric practice particularly in infants. Hence, antibiotic prescription should be done according to standardized guidelines. Endoscopic examination can demonstrate definite organic lesions that are necessary for diagnosis. However, a negative endoscopy with normal findings has its role in either reassurance of parents and diagnosis of functional disorders