Correlation between Gastrointestinal Bleeding in Pediatric Age and Endoscopic Findings

Abstract

Background: Gastrointestinal (GIT) bleeding in children is a common but potentially serious condition with diverse etiologies that vary between regions. Endoscopy remains the cornerstone for diagnosis and management. This study evaluates the epidemiological characteristics, etiologies, and endoscopic findings of pediatric GIT bleeding in Baghdad Medical City. Methods: A combined retrospective and prospective study was conducted on 100 children aged from birth to 18 years admitted with upper or lower GIT bleeding between January and December 2024. Data included demographics, clinical presentation, associated conditions, bleeding characteristics, endoscopic findings, histopathology, interventions, and outcomes. Patients underwent either esophagogastroduodenoscopy (OGD), colonoscopy, or both. Results: Of the 100 patients, 48 underwent OGD, 52 underwent colonoscopy, and 4 underwent both. Bleeding per rectum (hematochezia) was the most common presentation (49%), followed by hematemesis (27%). Children <5 years constituted the largest age group (46%). Upper GIT bleeding was most frequently caused by esophageal varices (12%) and gastritis (12%), while colonic polyps (16%) represented the most common cause of lower GIT bleeding. Normal endoscopic findings were seen in 19% of patients, often associated with short bleeding duration, mild bleeding, and younger age. Histopathology confirmed juvenile polyps, gastritis, ulcerative colitis, and Crohn’s disease among biopsied cases. Formula-fed infants showed a higher rate of gastritis and nonspecific colitis. Endoscopic interventions—including variceal banding, sclerotherapy, hemoclips, and polypectomy—successfully controlled bleeding in most cases. Overall, 97% of patients had favorable outcomes, while three deaths were attributed to severe, uncontrolled bleeding associated with advanced liver disease or obscure bleeding sources. Conclusion: Most pediatric GIT bleeding cases in this cohort were due to benign and treatable conditions. Lower GIT bleeding predominated, with colonic polyps being the leading cause. Endoscopy demonstrated high diagnostic and therapeutic value. Early evaluation, adequate bowel preparation, and improved access to advanced diagnostic modalities can further enhance outcomes.