Measurement of serum TNF-alpha as an accurate marker in diagnosing extrahepatic biliary atresia

Most diagnostic tests for biliary atresia [BA] are invasive. This study evaluates the sensitivity and specificity of serum tumor necrosis factor-alpha [TNF-alpha] for diagnosing extra hepatic biliary duct atresia [EHBA] in infants. Infants with cholestasis who were admitted to Children's Medical Center Hospital were evaluated. A total of 50 infants [20 with EHBA and 30 non-EHBA] were included in this study. We evaluated the definite cause of cholestasis. Intra-operative cholangiography and, if possible, Kasai portoenterostomy were performed in infants with high suspicion for EHBA. Upon admission and prior to surgical intervention, infants had their serum TNF-alpha levels measured by ELISA. We compared the mean TNF-alpha level between the two groups, in addition to the sensitivity and specificity of serum TNF-alpha for diagnosis of EHBA. This study enrolled 28 [56%] male and 22 [44%] female infants. Infants'' mean age was 2.87 months in the EHBA group and 2.6 months in the non-EHBA group. Sensitivity of serum TNF was 60% and its specificity was 76.66% for predicting EHBA. The positive predictive value was calculated as 63.1%, the negative predictive value was 74.1%, and accuracy was 70%. There was a significantly higher mean serum TNF-alpha level in the EHBA group [220 pg/ml] compared to the non-EHBA group [79.8 pg/ml, p=0.023]. Serum TNF-alpha cut off point for determining EHBA from non-EHBA was calculated as 80 pg/ml. Mean serum TNF-alpha in males [171.28 pg/ml] was more than females [90.80 pg/ml]. There was a significantly higher mean serum TNF-alpha level in the EHBA group than the non-EHBA group. Serum TNF-alpha could be a proper test that has comparatively good sensitivity, specificity, positive predictive value and negative predictive value for predicting EHBA

Probiotics for the treatment of pediatric helicobacter pylori infection: a randomized double blind clinical trial

Helicobacter pylori is recognized as a major etiological factor in the pathogenesis of gastritis and peptic ulcer disease. H. Pylori eradication has a failure rate of more than 30% in pediatric patients, particularly because of poor compliance, antibiotic resistance and occurrence of side-effects. This study was aimed to determine whether adding the probiotics to a standard anti-H. pylori regimen could minimize the gastrointestinal side-effect prevalence and improve the eradication rate. Double-blind randomized placebo controlled study conducted at Children's Medical Center in Tehran, Iran. Sixty six H. pylori positive children were treated with a triple drug treatment protocol [omeprazole+amoxycillin+furazolidon] and randomly allocated to receive either probiotic or placebo. All patients underwent esophagogastroduodenoscopy. H. pylori infection was diagnosed by either rapid urease test [RUT] or histology. H. pylori status was assessed after 4-8 weeks of the completion of treatment with stool H. pylori antigen test. The side effects of the treatment were determined in each group. Mean age of patients was 9.09 [range 3-14] years, 44 [65.7%] patients were boys [sex ratio 2:1]. All 66 patients completed the course of treatment and follow-up. The rate of H. pylori eradication was significantly higher in probiotic group [P=0.04]. In probiotic supplemented children there was a lower rate of nausea/vomiting [P=0.02] and diarrhea [P=0.039] during treatment. This study showed that probiotics have positive effect on the eradication of H. pylori infection. Adjuvant therapy with probiotic is recommended in order to reduce the frequency of antibiotic induced side-effects during treatment with antibiotics

Diagnosis of spontaneous bacterial peritonitis in children by reagent strips

This study was aimed to evaluate the efficacy of dipstick tests [leukocyte esterase and nitrite] in diagnosis of spontaneous bacterial peritonitis [SBP] in cirrhotic patients. Forty six children with ascites hospitalized between 2009 and 2010 in Children Medical Center were enrolled in this study. Reagent strip assays for leukocyte esterase and nitrite were performed on ascetic fluid and the results were compared to manual cell counting and ascitic fluid culture. SBP was defined as having a polymorphonuclear ascites count of >/= 250/mm[3]. Twenty children were female and twenty six were male with mean age of 3 +/- 3.9 years. The sensitivity specificity, positive and negative predictive values of the leukocyte esterase reagent strips were all 100%. The sensitivity, specificity, positive and negative predictive value of the nitrite reagent strip test were 100%, 97%, 90% and 100% respectively. Leukocyte esterase reagent strips may provide a rapid, bedside diagnostic test for the diagnosis of SBP

Gastroesophageal Reflux Disease and Tooth Erosion: A Cross-Sectional Observational Study

BACKGROUND/AIMS: Gastroesophageal reflux disease (GERD) is common in children. Recurrent exposure to gastric acid in GERD may contribute to tooth erosion. METHODS: In this prospective study, 54 GERD patients qualified according to endoscopy, pH-metry, and the GERD questionnaire and 58 healthy controls qualified by the GERD questionnaire were assessed. Two groups underwent dental evaluations for the presence, severity, and patterns of erosion and for the stage of dentition using a Tooth Wear Index. The health care providers who performed the dental exams did not know which children had been diagnosed with GERD. RESULTS: A total of 112 children, 3 to 12 years old were enrolled in the study, and 53 of 54 (98.1%) GERD patients and 11 of 58 (19.0%) controls had dental erosions (p<0.0001). In GERD patients, the posterior occlusal surfaces of milk teeth were more affected (p<0.0001). There was no correlation between GERD and the affected surfaces in permanent teeth, nor in the patterns or erosion grades (localized or general). In both groups, milk teeth had more erosions than permanent teeth, but the difference was not statistically significant. CONCLUSIONS: According to this study, there is a positive correlation between GERD and dental erosion. Posterior occlusal surface erosions in milk teeth could indicate GERD.

Role of Fecal Calprotectin in Differentiating between Hirschsprung's Disease and Functional Constipation / 대한소화기학회지

BACKGROUND/AIMS: Calprotectin is a 36.5 kD calcium and zinc binding protein in the S100 protein family. Fecal calprotectin levels are elevated in patients with inflammatory bowel disease and some other gastrointestinal disorders such as colorectal carcinoma. We decided to evaluate the fecal calprotectin level to see if it was able to distinguish between functional and organic causes of constipation. METHODS: Seventy-six children aged 1 to 120 months that all underwent deep rectal mucosa biopsies at Children Medical Center from November 2010 till September 2011 were recruited. Nineteen cases were diagnosed as Hirschsprung's disease and 57 of the patients had nerve ganglion cells in their biopsies. Calprotectin concentration was analyzed by the ELISA method. RESULTS: Although there was a significant difference between the median of the two groups (p=0.036), the median was not above the predetermined cutoff value of 50 microg/g. CONCLUSIONS: We propose that fecal calprotectin, using the above cutoff value, has limited value in differentiating functional constipation from Hirschsprung's disease.

Ultrasonographic triangular cord sign and gallbladder abnormality in diagnosis of biliary atresia

Early diagnosis of biliary atresia is very important for better outcome of treatment. Ultrasonography is one of the diagnostic tools for early differentiation of biliary atresia from other causes of neonatal cholestasis. It has been reported that triangular cord sign [TACS] in sonography is a reliable sign for diagnosis of biliary atresia. The aim of this study was to re-assess the accuracy of TACS alone and coupled with an abnormal gallbladder in the diagnosis of biliary atresia. Infants with prolonged cholestatic jaundice underwent ultrasonography and liver biopsy. Results of ultrasound scans [TASC and gallbladder abnormality] were compared with histopathological findings. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of Ultrasonographic findings for diagnosis of biliary atresia based on liver histopathology were studied. The sensitivity, specificity and accuracy of TACS for diagnosis of biliary atresia were 36%, 95% and 77% respectively. Positive predictive value and negative predictive value was 77%. The sensitivity and specificity of gallbladder abnormality for diagnosis of biliary atresia were 36% and 88% respectively. Positive predictive value of TACS coupled with gallbladder abnormality for diagnosis of biliary atresia was 100%. The Ultrasonographic TACS is very specific for diagnosis of biliary atresia. Positive predictive value and accuracy of this sign is much higher than of gallbladder abnormality. The sensitivity of TACS for diagnosis of biliary atresia is very low

Prevalence of portal vein thrombosis following umbilical catheterization in neonatal period

Portal venous thrombosis [PVT] is one of the most common causes of extrahepatic portal hypertension in children that may be occurring following umbilical venous cauterization or omphalities during neonatal period. We investigated the effects of umbilical cauterization during neonatal period on portal vein thrombosis. This study investigated the frequency of thrombosis of portal vein in term or preterm infants following umbilical catheterization by color doppler ultrasound. Fifty neonates who had age range [3.6+ 8days] and birth weights 1250- 4230 gram were recruited for this study and umbilical venous catheters were placed on neonates. All parents of these neonates signed a consent form. Color doppler ultrasound sonography of the portal vein was performed by two expert radiologists within 3 days following umbilical cauterization and serially for at least a period of 6 months intervals up to 3 years [6 times for each case]. Ten children were excluded from the study because of lack of follow up. Forty children completed the study. From total of 40 subjects, portal vein thromboses were detected in two children [1 girl, 1 boy] with age 2.5 and 1.5 years respectively. In these two children, other clinical signs of portal vein thrombosis manifested such as esophageal and stomach varices and splenomegaly confirmed by endoscopy. In all the other children, the physical examinations and ultrasounds were normal during 6 stages. It is recommended that care be exercised during cauterization placement in order to prevent thrombosis of the portal vein from occurring

Upper endoscopic findings in children with recurrent abdominal pain: high prevalence of hiatus hernia

Recurrent abdominal pain [RAP] by itself is one of the common reasons in child-aged patients to refer to a clinician. Some of these patients are presented with more serious features, so-called the "red flag". The most important issue in management of RAP is to distinguish the type of it, whether it is functional or organic. In this study we aimed to assess the redundancy of red-flagged RAP with findings of esophago-gastro-deudonoscopy. In a 2 year prospective study 150 consecutive children with RAP who showed red flags underwent esophago-gastro-deudonoscopy. The prevalence of each finding was recorded. Overall positive predictive value of predicting an endoscopic finding while having a red-flag was calculated. Among all the patients, 126 cases showed at least a positive finding in their endoscopy that corresponded to the positive predictive value of 84% for predicting the presence of an endoscopic finding according to red flags. Interestingly, 20% of patients showed hiatus hernia when surveyed. Comprehensive physical examination is needed to avoid performing esophago-gastro-deudonoscopy without indication in patients with recurrent abdominal pain

Atomic absorption spectrometry in Wilson's disease and its comparison with other laboratory tests and paraclinical findings

Wilson's disease [WD] is an autosomal recessive disease with genetic abnormality on chromosome 13 causing defect in copper metabolism and increased copper concentration in liver, central nervous system and other organs, which causes different clinical manifestations. The aim of this study was to determine the sensitivity of different clinical and paraclinical tests for diagnosis of Wilson's disease. Paraffin blocks of liver biopsy from 41 children suspicious of WD were collected. Hepatic copper concentrations were examined with atomic absorption spectrophotometry [Australian GBC, model: PAL 3000]. Fifteen specimens had hepatic copper concentration [dry weight] more than 250 micro g/g. Clinical and laboratory data and histologic slides of liver biopsies of these 15 children were reviewed retrospectively. Liver tissue was examined for staging and grading of hepatic involvement and also stained with rubeonic acid method for copper. Patients were 5-15 years old [mean age=9.3 years, standard deviation=2.6] with slight male predominance [9/15=60%]. Five [33%] patients were 10 years old. Three [20%] of them were referred for icterus, 8 [54%] because of positive family history, 2 [13%] due to abdominal pain and 2 [13%] because of hepatosplenomegaly and ascites. Serum AST and ALT levels were elevated at the time of presentation in all patients. In liver biopsy, histological grade and stage was 0-8 and 0-6 respectively, 2 [13%] had cirrhosis, 1 [7%] had normal biopsy and 12 [80%] showed chronic hepatitis. Hepatic copper concentrations were between 250 and 1595 micro g/g dry weight. The sensitivity of various tests were 85% for serum copper, 83% for serum ceruloplasmin, 53% for urinary copper excretion, 44% for presence of KF ring and 40% for rubeonic acid staining on liver biopsies. None of the tests stated in the article were highly sensitive for diagnosis of WD, so we suggest that diagnosis should be based on combination of family history, physical examination and different tests

Comparison of classic sweat test and crystallization test in diagnosis of cystic fibrosis

Sweat chloride measurement is considered a standard diagnostic tool for cystic fibrosis [CF]. This study was performed to compare sweat chloride values obtained by quantitative pilocarpine iontophoresis [classic test] with sweat crystallization detected by direct observation of a drop of perspiration under light microscopy in patients with and without CF. The tests using both techniques were performed simultaneously in patients with and without CF. Cutoff values of >/= 60 mmol/L of chloride concentration for the classic sweat test was considered for diagnosis of CF. In crystallization method, observation of typical dendritic forms of salt crystals under light microscopy was interpreted positive. Sixty patients suspected to CF [31 males and 29 females] with age range of 9 months to 2 years underwent the sweat test using both techniques. Median sweat chloride values was 26.13+10.85 in group with negative and 72.76+12.78 mmol/L in group with positive sweat test, respectively. All the patients who had positive sweat test in classic method showed typical dendritic forms of salt crystal in sweat crystallization test, which provided the test with 100% sensitivity [95%CI: 93.1-100]. Only one of the 31 subjects with negative results for classic sweat test had positive result for crystallization sweat test, which provided the test with 96.7% specificity [95%CI: 92.9-100]. Time spent to perform the crystallization test was significantly shorter than the classic method whereas its cost was also lower than the second method. There was a good correspondence between two studied methods of sweat test. These results suggested the sweat crystallization test as an alternative test for detecting CF disease with high sensitivity and specificity

Prevalence of occult celiac disease in healthy Iranian school age children

Several studies have shown the prevalence of celiac disease [CD] to be around 1% in Iran, which is similar to the worldwide prevalence. There is scant information on occult CD in apparently healthy school age children. This study, as the first such study in Iran, aims to determine the prevalence of occult CD in healthy Iranian school age children. In this cross-sectional study, we screened healthy school age children for CD by serum IgA and IgA anti-tissue transglutaminase antibody [tTG] levels. Measurement of these antibodies was by enzyme linked immunosorbent assay. A recheck of positive tTG tests was performed and patients who tested positive underwent endoscopic duodenal biopsies. The biopsy samples were scored according to the Marsh classification by an experienced pathologist. A total of 634 children [314 males, 320 females; mean age: 12.8 years] were included in the study. All children and/or their parents completed a questionnaire and children underwent an initial physical examination to determine study eligibility. Positive serum tTG was noted in 3 [0.5%; 2 females] out of 634 patients. Duodenal biopsies were consistent with CD in these 3 subjects. The mean age of patients with CD was 14.3 years [range: 12-17 years]. The female to male ratio was 2:1. These cases had no signs and symptoms, but a gluten-free diet was recommended according to pathologic changes in their small bowels and results of the tTG test. The prevalence of occult CD in these children is 0.5%, which is half of the prevalence of CD in Iranian adults. The anti-tTG concentration at initial serological CD screening is highly informative in determining occult cases of CD. The question is whether all non-symptomatic cases should be treated with a gluten-free diet or not

Red flags of organic recurrent abdominal pain in children: study on 100 subjects

A variety of sign, symptoms and laboratory findings are more common in children with organic abdominal pains. This study was performed to evaluate the prevalence of organic and functional abdominal pains and relation of red flags to organic pains in 100 children with recurrent abdominal pain [RAP]. One hundred consecutive patients with RAP were enrolled in the study. A complete interview and physical examination was made for each patient, accompanied by a series of laboratory, clinical and paraclinical examinations. The data were recorded and analyzed. Logistic regression analysis was used to model and formulize correlations between sign, symptoms, and laboratory findings with organic and functional abdominal pain. Among 100 patients [52% male, 48% female, Age: 9.29 +/- 3.17] diagnostic works up revealed organic pain for 57 patients. The most common symptoms of the patients included constipation, diarrhea, chest pain, cough, headache, vomiting, hematuria, and dysuria. Fecal incontinence, delayed puberty, organomegaly, jaundice, and family history of inflammatory bowel disease were reported in none of the patients with RAP. Fever, pain not located in periumbilical area, nocturnal pain, elevated erythrocyte sedimentation rate, weight loss, growth disorder, and abdominal tenderness were among the red flags which revealed diagnosis of organic pain in this study. A series of red flags could increase likelihood of finding organic pain in children with RAP

Prevalence of celiac disease in Iranian children with recurrent abdominal pain referred to a pediatric referral center

Clinical features of Iranian children with celiac disease [CD] are still unknown and there is scant information about atypical presentation of celiac disease from Iran. The aim of this study was to determine prevalence of CD in Iranian children presenting with functional abdominal pain [FAP]. In this cross-sectional study, 301 children affected by FAP were screened for CD by anti-tissue transglutaminase antibody [tTG IgA]. IgA antibody was also measured to exclude IgA deficiency. The antibodies were measured by enzyme linked immunosorbent assay. Diagnosis of CD was confirmed by duodenal biopsy that was scored according to the Marsh classification in cases with abnormal titer of tTG antibody. A total of 301 children [138 males, 163 females] with FAP were studied. Endoscopic duodenal biopsy was taken for patients with positive and borderline tTG test. Two out of 301 cases were IgA deficient and celiac disease was suspected for one of them based on histological findings. Four out of 299 patients with normal IgA had abnormal tTG titer; intermediate ranges [16-23 U/ml] were detected in 1 and positive ranges [>/=24 U/ml] in 3 cases. CD was suggested in all patients with abnormal titer of tTG [1.33%] based on histological findings. The prevalence of celiac disease in children with FAP is estimated 1.3% [nearly 2 times higher than in normal population] in Iran

Cow's Milk Allergy among Children with Gastroesophageal Reflux Disease

BACKGROUND/AIMS: Gastroesophageal reflux disease (GERD) and cow's milk allergy (CMA) are two common conditions that occur in infancy. This study was performed to investigate the frequency of CMA in a group of patients with GERD. METHODS: Eighty-one children with signs and symptoms of GERD were enrolled in this study. All subjects received omeprazole for 4 weeks after the initial evaluation. Empirical elimination of cow's milk from the diet was started for the patients who did not respond to the omeprazole treatment. RESULTS: Seventy-two cases presented with gastrointestinal signs and symptoms, whereas the remaining nine cases presented with respiratory complaints. After the initial treatment with omeprazole, two thirds of the cases (54 patients, 66.7%) responded well, and all of their symptoms were resolved. Cow's milk was eliminated from the diets of the remaining 27 patients. All signs and symptoms of GERD were resolved in this group after a 4 week elimination of cow's milk from the diet. CONCLUSIONS: A diagnosis of CMA was considered in one third of the pediatric cases with signs and symptoms of GERD. This finding shows that CMA can mimic or aggravate all signs and symptoms of severe GERD during infancy.

Coincidence of Niemann-Pick disease and beta-thalassemia; a case report

Niemann-Pick disease and beta-thalassemia are distinct conditions with specific clinical and morphological manifestations. Beta-thalassemia is the most common inherited blood disorder in Iran whereas Niemann-Pick disease, a lysosomal storage disorder, is rarely found in this country. This 5-month old girl, a known case of beta-thalassemia major was hospitalized for failure to thrive and hepathosplenomegaly. Because of unusual splenomegaly and liver enzymes disturbance that was not compatible with the first diagnosis, further evaluation revealed cherry red spot and high lipid profile suggestive of lysosomal storage disease. Foamy cells in the bone marrow and low activity of the specific enzyme led to the diagnosis of Niemann-Pick disease. This unique case illustrates the importance of looking for a second pathological condition in a patient whose clinical profile does not support the first diagnosis in its entirety

Comparing oral route paraffin oil versus rectal route for disimpaction in children with chronic constipation; a randomized control trial

Functional constipation is a common and challenging problem in pediatrics. Fecal disimpaction prior to maintenance therapy is recommended to ensure successful treatment. The aim of this study was to compare the efficacy and patient's compliance of the two methods of paraffin oil administration [oral and rectal route] with the purpose of disimpaction in treatment of children with functional constipation. A total of 80 children [49 males and 31 females] aged 1-12 years, with functional constipation according to Rome III criteria, whose rectal examination confirmed fecal impaction were divided into two groups randomly. Group I received 3 ml/kg/day paraffin oil orally and group II received 3ml/kg/day paraffin oil rectally during 3 consequent days. Successful treatment was defined as no detectable fecal impaction in rectal examination after at most 72 hours. Patient compliance and family satisfaction also was evaluated using a scored questionnaire. Response to the treatment in both groups was with 92.5% and 82.5% in group I and II, respectively. So, there was no significant difference between the two methods of therapy. Family satisfying and compliance were obviously more achieved in group 1 [87.5% vs 57.5%] than in Group 2 [P<0.001]. No parents in group I complained about type of treatment while 12.5% of parents in group II were unsatisfied with the mode of paraffin oil administration. The most common side effect of paraffin oil in both groups was anal oil seepage [27.5%]. Nausea and abdominal pain were more common side effects in group 1 and 2 respectively. It seems that using paraffin oil per oral route in comparison with rectal route could be a preferred option for disimpaction in children causing less anxiety to the family

Breastfeeding and Helicobacter pylori infection in children with digestive symptoms

This study aims to evaluate the role of breastfeeding in the acquisition of Helicobacter pylori [H. pylori] infection in Iran and to compare the histopathologic changes occurring in children feeding on breast milk with those in infants feeding on formula. In a case-control study parents of children with and without H. pylori infection who had undergone endoscopic survey and gastric biopsy in the Children's Medical Center, Tehran, were asked about their feeding practices during the first 6 months after birth, the duration of breastfeeding period, the symptoms, and the duration of symptoms and concomitant diseases. A total of 154 children were included in this study. From this sample, 77 children formed the case group and 77 children formed the control group. A significant difference was found between H. pylori infection and feeding with formula [P=0.045]. In case group, a significant difference was found between breastfeeding and age of the infected child [P=0.034], shorter duration of symptoms [P=0.016], and finally degree of H. pylori colonization [P=0.021]. It appears that breastfeeding in the first 6 months after birth can decrease the degree of H. pylori colonization, postpone infection until older age, shorten the duration of symptoms, and be concomitant with milder gastritis

Reinfection rate after successful Helicobacter pylori eradication in children

Reinfection rate of Helicobacter pylori after successful eradication is low in developed countries. This study was performed to determine the reinfection rate of H. pylori during a follow up period of 12 months in Iranian children. In this prospective study, children with H. pylori infection were treated with triple omeprazole based regimen. Patients with negative [13]C urea breath test [UBT] performed after 8 weeks of therapy, were followed up by the same test after 1 year. Thirty seven patients, aged 5 to 17 years, were studied. Among them 25 [67.5%] were boys. After eradication therapy of H. pylori, 34 patients had negative [13]C UBT. Reinfection occurred in 5 [14.7%] patients. Reappearance or continuing symptoms after treatment were associated with higher rate of recurrence [P=0.042]. Recurrence rate of H. pylori was high in our children. Successful eradication significantly decreased complaints and further symptoms. Follow up and reevaluation of patients is necessary especially when there are symptoms after eradication

Success rate of furazolidone-based triple therapy for eradication of helicobacter pylori in children

Helicobacter pylori [H. Pylori] is now recognized as a major etiological factor in the pathogenesis of gastritis and peptic ulcer disease. There is concrete evidence that eradication of the bacterium reverses histological gastritis, and results in significant reduction of duodenal and gastric ulcer recurrence. Poor compliance and antibiotic resistance are the main causes for failure of anti H. pylori therapy. In this study we determined efficacy of omeprazole based triple therapy with b.i.d. dosing of furazolidone, amoxicillin for 2 weeks and omeprazole in Iranian children. This prospective study included 37 children, in whom H. Pylori infection was diagnosed endoscopically. H.Pylori positive children were treated with a two weeks course of furazoidone [6 mg/kg/day] and amoxicillin [50 mg/kg/day] plus omeprazole [1-2 mg/kg/day]. Eradication was assessed by 13C UBT. Mean age of patients was 10.2 yr [5-15 yr], 25 [67.5%] patients were boys. H. Pylori was eradicated in 34 children [per patient 91.9%, per protocol 86%]. Side effects occurred in 3 [8.1%] patients, but these were mild and it was not necessary to discontinue treatment. Three children [8.1%] remained H. pylori positive. Our study showed that the association of furazolidone plus amoxicillin with a proton-pump inhibitor could be a valuable alternative for eradication of H. Pylori infection in children. It is an effective, affordable treatment that allows good compliance and produces low adverse effect rates

Colorectal polyps: a clinical, endoscopic and pathologic study in Iranian children

To study the clinical presentation, histology and colonoscopic features of lower gastrointestinal polyps in Iranian children. Medical reports of children with colorectal polyps were retrospectively reviewed from 1996 to 2005 at the Children's Medical Center Hospital, Iran. A total of 563 cases were studied. Data related to age, sex, family history, signs and symptoms, the size, location, polyp types and associated lesions were collected and analyzed. The mean age of children was 5.66 +/- 2.88 years [range 2 months to 17 years], with a male-to-female ratio of 1.61:1.0. The highest incidence was between ages 2 and 10 years [85.1%]. Rectal bleeding was the presenting symptom in 78.5% cases. The polyps were solitary in 94% of cases. A majority of polyps [86.3%] were juvenile and 86.7% located in the rectosigmoid area. Three percent of cases had a positive family history. One case of Turcot syndrome was also identified. Juvenile polyps remain the most common polyps in Iranian children. Although the presence of a solitary polyp in the rectosigmoid colon is more prevalent, in a significant number of cases they are multiple and located in proximal parts. Polyps must be removed even when asymptomatic because of their probable neoplastic potential