Pediatric Colonoscopy:Clinical Presentation And Colonoscopy Findings

Objective In pediatric, colonoscopy examination has become a common procedure for diagnostic and therapeutic purpose. However, there are limited data on pediatric. This study aimed to determine demographic characteristic, clinical presentation, colonoscopy findings, and to encourage routinely report assessment of bowel preparation quality(BPQ) using Boston Bowel Preparation Scale(BBPS).Methods This five years descriptive retrospective study, conducted at Children’s Hospital of Chongqing Medical University. All patient(≤18 years of age) who had colonoscopy from July 2010 to December 2014 was included. Patient was categorised as <18months, 18months-3years, 3years-6years, and >6years and the findings was reported separately in each group. Data on age, sex, clinical presentation and colonoscopy findings was collected and analysed. All the patient bowel preparation method was followed as per hospital protocol and the BPQ assessed using BPPS.Results Overall, our series included a total of 902 pediatric patients with a mean age of 5.2±4.0 years(range:0-17.5years). There was 597(66.1%) boys and 205(33.8%) girls with ratio 2:1. Among these, the distribution by age groups was 198(21.9%) patients in <18months, 174(19.2%) patients in 18months-3years, 222(24.6%) patients in 3years-6years, and 308(34.1%) patients in >6years old.The most common presenting symptoms was hematochezia in 565(62.6%) patients, diarrhea in 206(22.8%) patients, and abdominal pain in 172(18.8%) patients. Other presenting symptoms was fever in 77(8.5%) patients, pallor in 25(2.7%) patients, melena in 15(1.6%) patients, prolapse of polyp in 9(0.9%) patients, oral pigmentation in 7(0.7%) patients, no weight gain in 2(0.2%) patients and others in 21(2.4%) patients.Nearly 652(72.2%) patients had positive findings with the main findings being Polyp(s) in 302(33.4%) patients, Unspecific Colitis in 131(14.5%) patients and Food Induced Proctocolitis(FPIPC) in 108(11.9%) patients. This was followed by haemorrhoid in 63(6.9%) patients, anal fissure in 39(4.3%) patients, Pseudomembrane colitis(PMC) in 21(2.4%) patients, Proctitis in 28(3.1%) patients, Inflammatory Bowel Disease(IBD) in 11(1.2%) patients, Henoch Schonlein Purpura in 13(1.4%) patients, and Intestinal Tuberculosis in 8(0.8%) patients. In small percentage some of rare diseases like Primary Intestinal Lymphoangiectasia, Behcet’s disease and Peutz-Jeghers syndrome in 3(0.1%) patients each respectively was found.Children diagnosed with polyp(33.4%) with median age 4 years presented with hematochezia, while FPIPC(10.6%) was most common findings in age <18months presented with hematochezia and diarrhea. IBD(1.2%) was significantly in older children in age >6years presented with abdominal pain and hematochezia.Children at our hospital undergo 2 days preparation. On first day of preparation, patients was restricted to clear liquid diet and on day of colonoscopy nil per oral. For bowel cleaning we choose different medications according to different age group. Lactulose is given for less than 3years old and polyethylene glycol(PEG) and Senna for more than3years. The bowel cleaning was evaluated using BBPS, 98.7% reported >5, with median score 9.0.Conclusion The mean age of colonoscopy performing procedure is decreasing with higher incidence of positive findings in children compared to adults. So, far the most common colonoscopy findings in children was polyp(s) presented with hematochezia, which was mostly true in age group more than 18 month, but in less than 18 months the most predominant findings was FPIPC presented with hematochezia and diarrhea. IBD was significantly higher in older children in age >6years presented with abdominal pain and hematochezia. The age of onset symptoms can varied diagnosis according to age. The protocol used for bowel cleansing was evaluated from BPPS showed effective.Bowel preparation for colonoscopy in children is a challenging procedure. Wide variety of preparation protocols exist, varying with the hospital. Unlike in adults, there is a lack of uniform bowel preparation protocol in children. Ideally, the bowel preparation agents are assessed by their safety, efficacy and tolerability. Unfortunately, none of the preparations currently available meets all of these criteria. However, since last decade, Polyethylene Glycol-3350(PEG-3350) is gaining popularity for bowel preparation with reported safety, efficacy, and tolerability. The only major drawback of PEG-3350 without electrolyte was 4 days long preparation time thus raising the question if the duration of preparation time could be minimised and yet have same efficacy, safety, and tolerability of the medicine. Hence, one day PEG-3350 regimen was introduced eventually and is now being studied with increased dosage or combined with other laxatives. This is the first review which compiles the study so far conducted on one day PEG-3350 without electrolyte as colonoscopy bowel preparation in children and tries to summaries if this regimen can be commonly used in children for colonoscopy bowel preparation.Background: Concerns still exist with respect to unsatisfactory eradication rates and/or therapy associated side effects for the use of standard triple therapy in the treatment of Helicobacter pylori infection, which prompts considerable interest in new therapy. We systematically reviewed the literature to investigate whether Lactobacillus GG as supplementation to standard triple therapy could improve H. pylori eradication rates and/or reduce therapy-associated side effects.Methods: Pub Med, EMBASE, the Cochrane Central Register of Controlled Trials(CENTRAL) were systematically searched from their inception to August 4, 2015 for randomized controlled trials(RCTs). The language was restricted to English only.Results: Four RCTs involving a total of 305 participants(including 83 children) were included. Lactobacillus GG given along with triple therapy significantly reduced the risk of overall H. pylori therapy-related adverse effects(three RCTs, n = 221, RR 0.59, 95% CI 0.45- 0.78), particularly of diarrhea(four RCTs, n = 285, RR 0.23, 95% CI 0.11- 0.47), bloating(four RCTs, n = 289, RR 0.61, 95% CI 0.41- 0.90), and taste disturbance(four RCTs, n = 288, RR 0.38, 95% CI 0.23- 0.62). There were no significant differences between groups in the risk of other adverse effects. No beneficial effects of Lactobacillus GG were observed for H. pylori eradication rates(four RCTs, n = 284, RR 0.99, 95% CI 0.88- 1.13).Conclusion: Current evidence indicates that Lactobacillus GG administered along with standard triple therapy is a feasible way to reduce therapy-related side effects, particularly diarrhea, bloating, and taste disturbance. However, Lactobacillus GG shows no effects on eradication rates.