Diagnostic findings and long-term prognosis in children with anemia undergoing GI endoscopies.,Gastrointestinal Endoscopy

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Diagnostic findings and long-term prognosis in children with anemia undergoing GI endoscopies.
Gastrointestinal Endoscopy ( IF 6.7 ) Pub Date : 2020-01-07 , DOI: 10.1016/j.gie.2019.12.042
Marleena Repo ₁ , Teemu Rajalahti ₂ , Pauliina Hiltunen ₂ , Antti Sotka ₃ , Laura Kivelä ₄ , Heini Huhtala ₅ , Katri Kaukinen ₆ , Katri Lindfors ₇ , Kalle Kurppa ₈

Affiliation

Tampere Centre for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Finland; Department of Pediatrics, Tampere University Hospital, Tampere, Finland; Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Finland.
Tampere Centre for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Finland; Department of Pediatrics, Tampere University Hospital, Tampere, Finland.
Department of Pediatrics, South Karelia Central Hospital, Lappeenranta, Finland.
Tampere Centre for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Finland; University of Helsinki and Helsinki University Hospital, Children's Hospital, and Pediatric Research Center, Helsinki, Finland.
Faculty of Social Sciences, Tampere University, Tampere, Finland.
Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Finland; Department of Internal Medicine, Tampere University Hospital, Tampere, Finland.
Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Finland.
Tampere Centre for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Finland; Department of Pediatrics, Tampere University Hospital, Tampere, Finland; The University Consortium of Seinäjoki, Seinäjoki, Finland.

BACKGROUND AND AIMS Intestinal diseases are regarded as a common cause of anemia, but the diagnostic outcomes of children with anemia undergoing endoscopic investigations are unclear. We investigated this issue in a large cohort of children. METHODS Indications for and findings of consecutive gastrointestinal (GI) endoscopies were collected. Clinical presentation and diagnostic outcomes were compared between anemic and nonanemic patients and between anemic patients with and without a diagnosis. Diagnoses received during follow-up were collected. RESULTS Of 2395 consecutive endoscopies, 251 children with and 613 children without anemia had undergone either diagnostic esophagogastroduodenoscopy (EGD) (51.4% and 51.4%, respectively), colonoscopy (4.0% and 11.4%), or both (45.8% and 37.8%). Children with anemia more often received diagnoses (72.9% vs 39.3%; odds ratio [OR], 4.18; 95% confidence interval [CI], 3.03-5.77), particularly of celiac disease (26.3% vs 15.5%, P < .001) and of inflammatory bowel disease (31.1% vs 9.1%, P < .001), than did nonanemic children. The diagnosis in anemic patients was predicted by age 5 to 12 years (OR, 3.52; 95% CI, 1.27-9.75), presence of diarrhea (OR, 2.04; 95% CI, 1.07-3.90), melena/hematochezia (OR, 2.40; 95% CI, 1.17-4.92), poor growth (OR, 3.94; 95% CI, 1.70-9.15), positive celiac serology (OR, 11.81; 95% CI, 3.47-40.12), high calprotectin (OR, 12.86; 95% CI, 4.00-41.32), hypersedimentation (OR, 2.65; 95% CI, 1.29-5.44), and hypoalbuminemia (OR, 5.05; 95% CI, 1.56-16.34). Thirty children with anemia (12.0%) had no GI symptoms, and 22 of them (73.3%) were given diagnoses at the time of the endoscopies. All 22 had additional laboratory abnormalities, whereas these were present in only 2 of 8 undiagnosed children. None of them was diagnosed later in the follow-up of up to 11 years, in contrast to 4 (6.7%) of all anemic and 33 (8.9%) of all nonanemic patients. CONCLUSIONS Anemia increased the probability of being given a diagnosis, emphasizing its importance as an alarm symptom. However, endoscopies in anemic patients without additional symptoms or laboratory abnormalities seldom improved the diagnostic yield.

中文翻译：

接受胃肠内镜检查的贫血儿童的诊断结果和长期预后。

背景与目的肠道疾病被认为是贫血的常见病因，但是尚不清楚接受内窥镜检查的贫血儿童的诊断结果。我们在一大批儿童中调查了这个问题。方法收集连续胃肠道（GI）内镜检查的指征和发现。比较贫血和非贫血患者以及有无诊断的贫血患者的临床表现和诊断结果。随访期间收集的诊断信息。结果连续2395例内镜检查中，有251例贫血儿童和613例无贫血儿童接受了诊断性食管胃十二指肠镜检查（EGD）（分别为51.4％和51.4％），结肠镜检查（4.0％和11.4％）或两者都进行了（45.8％和37.8％）。贫血儿童更常接受诊断（72。9％和39.3％；比值比[OR]，4.18；相比非贫血，置信区间[CI]为3.03-5.77，尤其是乳糜泻（26.3％vs 15.5％，P <.001）和炎症性肠病（31.1％vs 9.1％，P <.001）的可信度区间为953-5孩子们。贫血患者的诊断可通过5至12岁的年龄（OR，3.52; 95％CI，1.27-9.75），腹泻的存在（OR，2.04; 95％CI，1.07-3.90），melena / hematochezia（OR， 2.40; 95％CI，1.17-4.92），生长不良（OR，3.94; 95％CI，1.70-9.15），腹腔血清学阳性（OR，11.81; 95％CI，3.47-40.12），高钙卫蛋白（OR，12.86）； 95％CI，4.00-41.32），过度沉淀（OR，2.65； 95％CI，1.29-5.44）和低白蛋白血症（OR，5.05； 95％CI，1.56-16.34）。30例贫血儿童（12.0％）没有胃肠道症状，在内窥镜检查时有22例（73.3％）被诊断出。所有22例均具有其他实验室异常，而在8例未确诊的儿童中仅出现2例。在长达11年的随访中，没有一例被诊断出来，而所有贫血患者中有4名（6.7％）和非贫血患者中有33名（8.9％）。结论贫血增加了被诊断的可能性，强调了其作为警报症状的重要性。然而，没有其他症状或实验室异常的贫血患者的内镜检查很少能提高诊断率。

更新日期：2020-01-07

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