Lower Gastrointestinal Bleeding in Children: Etiologies, Colonoscopic Findings, and Outcomes from a Single Tertiary Center

Volume 16 , Issue 1 , July 2026

Authors

Karzan Mohammed Hasan 1 ; Adnan Mohammed Hasan 2 ; Karokh Hassan Salih 3

1 ABHS trainee in pediatric gastroenterology, hepatology, and nutrition, Dr. Jamal Ahmed Rashid Pediatric Teaching Hospital, DOH of Sulaimani, Sulaimani, Iraq

2 Branch of Clinical Medical Sciences, College of Medicine, University of Sulaimani, Sulaimani, Iraq.

3 Branch of Basic Medical Sciences, College of Medicine, University of Sulaimani, Sulaimani, Iraq.

DOI logo 10.17656/jsmc.10518

Keywords

Abstract

ABSTRACT

Background

Lower gastrointestinal bleeding (LGIB) refers to bleeding that occurs distal to the ligament of Treitz. It is a common problem in children.

Objectives

The aim of this study was to evaluate the clinical characteristics, etiologies, and diagnostic features of lower gastrointestinal bleeding (LGIB) in pediatric patients.

Patients and Methods

A retrospective cross-sectional study was conducted in the Department of Pediatric Gastroenterology and Hepatology at Dr. Jamal Ahmed Rashid Pediatric Teaching Hospital in Sulaimani from October 2023 to July 2025. Seventy-six children (aged 1–15 years) who presented with rectal bleeding and underwent colonoscopy were included. Data on demographics, clinical features, laboratory results, colonoscopic findings, and histopathology were collected and analyzed.

Results

Seventy-six patients were included, with male to female ratio of (1.7:1). The average age was 6.96 ± 4.26 years. Common presenting symptoms were bleeding per rectum, followed by abdominal pain and diarrhea. Normal colonoscopies were observed in 27 patients (35.5%). Frequent abnormalities found during colonoscopy were non-specific colitis followed by inflammatory bowel disease, juvenile polyps, and solitary rectal ulcer syndrome. Solitary rectosigmoid polyps constituted 90.9% of the identified polyps. There was a significant association between a history of anemia, weight loss, and additional symptoms, with underlying causes of lower gastrointestinal bleeding (p < 0.05). 

Conclusion

Lower gastrointestinal bleeding in children can be caused by a number of conditions, the most common being non-specific colitis, inflammatory bowel disease, and juvenile polyps. When assessing pediatric LGIB, colonoscopy is a crucial diagnostic and treatment tool.

References

  1. 1. Romano C, Oliva S, Martellossi S, Miele E, Arrigo S, Graziani MG, et al. Pediatric gastrointestinal bleeding: perspectives from the Italian Society of Pediatric Gastroenterology. World journal of gastroenterology. 2017 Feb 28;23(8):1328. doi: 10.3748/wjg.v23.i8.1328.
  2. 2. Sahn B, Bitton S. Lower gastrointestinal bleeding in children. Gastrointestinal Endoscopy Clinics. 2016 Jan 1;26(1):75-98.
  3. 3. Hajare S, Kantamaneni R. Etiological profile of patients with lower gastrointestinal bleeding: A 1-year cross-sectional study. Archives of Medicine and Health Sciences. 2018 Jul 1;6(2):300-2.
  4. 4. Thomson M, Tringali A, Dumonceau JM, Tavares M, Tabbers MM, Furlano R, et al. Paediatric gastrointestinal endoscopy: European society for paediatric gastroenterology hepatology and nutrition and European society of gastrointestinal endoscopy guidelines. Journal of pediatric gastroenterology and nutrition. 2017 Jan;64(1):133-53. doi: 10.1097/ MPG.0000000000001408.
  5. 5. Silbermintz A, Matar M, Assa A, Zevit N, Glassberg YM, Shamir R. Endoscopic findings in children with isolated lower gastrointestinal bleeding. Clinical Endoscopy. 2019 May 14;52(3):258-61. doi: 10.5946/ce.2018.046.
  6. 6. Jafari SA, Kiani MA, Kianifar HR, Mansooripour M, Heidari E, Khalesi M. Etiology of gastrointestinal bleeding in children referred to pediatric wards of Mashhad hospitals, Iran. Electronic physician. 2018 Feb 25;10(2):6341. doi: 10.19082/6341.
  7. 7. Comay D, Marshall JK. Resource utilization for acute lower gastrointestinal hemorrhage: the Ontario GI bleed study. Canadian Journal of Gastroenterology and Hepatology. 2002;16(10):677-82. doi: 10.1155/2002/156592.
  8. 8. Bai Y, Peng J, Gao J, Zou DW, Li ZS. Epidemiology of lower gastrointestinal bleeding in China: Single‐center series and systematic analysis of Chinese literature with 53 951 patients. Journal of gastroenterology and hepatology. 2011 Apr;26(4):678-82.
  9. 9. Zahmatkeshan M, Fallahzadeh E, Najib K, Geramizadeh B, Haghighat M, Imanieh MH. Etiology of lower gastrointestinal bleeding in children: a single center experience from southern iran. Middle East journal of digestive diseases. 2012 Oct;4(4):216.
  10. 10. Emara MH, Salama RI, Hamed EF, Shoriet HN, Abdel-Aziz HR. Non-specific colitis among patients with colitis: frequency and relation to inflammatory bowel disease, a prospective study. Journal of Coloproctology. 2019 Dec;39(04):319-25.
  11. 11. Talib MA, Aziz MT, Suleman H, Khosa GK, Joya SJ, Hussain I. Etiologies and outcome of lower gastrointestinal bleeding in patients presenting to a tertiary care Children’s Hospital. Pakistan journal of medical sciences. 2021 Mar;37(2):556. doi: 10.12669/pjms.37.2.2676.
  12. 12. El-Khair H, Deeb M, El-Zayat R. Colonoscopic findings in children with lower gastrointestinal bleeding. Menoufia Medical Journal. 2016;29(2):247-51.
  13. 13. Bhadauria N, Dubey SR, Mittal P, Arya AK, Singh RP. Clinico-etiological pattern of lower gastrointestinal bleeding in children (5-18 years age group) at a tertiary care center in central India. Indian Journal of Child Health. 2016 Dec 25;3(4):290-2.
  14. 14. Mandhan P. Sigmoidoscopy in children with chronic lower gastrointestinal bleeding. Journal of paediatrics and child health. 2004 Jul;40(7):365-8. doi: 10.1111/j.1440-1754.2004.00403.x.
  15. 15. Mohd Irtaza, Sundaram S, Amrit Gopan, Patra BR, Rao PK, Kumar S, et al. Lower gastrointestinal bleed in children: safety, utility, and yield of colonoscopy: an Experience from a large tertiary referral endoscopy center. Journal of Digestive Endoscopy. 2024 Mar;15(01):27-34.
  16. 16. Park JH. Role of colonoscopy in the diagnosis and treatment of pediatric lower gastrointestinal disorders. Korean journal of pediatrics. 2010 Sep 13;53(9):824. doi: 10.3345/kjp.2010.53.9.824.
  17. 17. Alrashidi S, AlAmery T, Alshanbary A, Aljohani E, Bashir SM, Alsaleem B, et al. Disease patterns among Saudi children undergoing colonoscopy for lower gastrointestinal bleeding: Single tertiary care center experience. Saudi Journal of Gastroenterology. 2023 Nov 1;29(6):388-95.
  18. 18. Thomson M, Sharma S. Diagnostic yield of upper and lower gastrointestinal endoscopies in children in a tertiary centre. Journal of Pediatric Gastroenterology and Nutrition. 2017 Jun;64(6):903-6.
  19. 19. Kim KM, Lee SH, Lee DJ, Kim KN, Seo SW, Lee HS, et al. A randomized controlled trial of comparison on time and rate of cecal and terminal Ileal intubation according to adult-colonoscope length: intermediate versus long. Journal of Korean medical science. 2014 Jan 1;29(1):98-105.
  20. 20. Zuber-Jerger I, Endlicher E, Gelbmann CM. Factors affecting cecal and ileal intubation time in colonoscopy. Med Klin (Munich) 2008 Jul;103(7):477-81.
  21. 21. Moravej H, Dehghani SM, Nikzadeh H, Malekpour A. Lower gastrointestinal bleeding in children: experiences from referral center in southern Iran. J Compr Ped. 2013 May 2;3(3):115-8.
  22. 22. Clarke G, Robb A, Sugarman I, McCallion WA. Investigating painless rectal bleeding—is there scope for improvement? Journal of pediatric surgery. 2005 Dec 1;40(12):1920-2.
  23. 23. Motamed F, Najafi Sani M, Khodadad A, Fallahi G, Farahmand F, Sobhani M. Colonoscopic findings in children with lower gastrointestinal bleeding. Govaresh. 2008;13(1):54-7.
  24. 24. Malik I, Sami A, Yousuf W, Tariq S, Jan S, Niyaz T. Etiological profile of lower gastrointestinal bleeding in children and adolescents from Kashmir; A tale of 5 years. Middle East Journal of Digestive Diseases. 2023 Jul 30;15(3):180.
  25. 25. Thakkar K, Alsarraj A, Fong E, Holub JL, Gilger MA, El Serag HB. Prevalence of colorectal polyps in pediatric colonoscopy. Digestive diseases and sciences. 2012 Apr;57(4):1050-5.
  26. 26. Albasri A, Yosef H, Hussainy A, Bukhari S, Alhujaily A. Profile of colorectal polyps: a retrospective study from King Fahad Hospital, Madinah, Saudi Arabia. Asian Pacific Journal of Cancer Prevention. 2014;15(6):2669-73.
  27. 27. Poddar U, Thapa BR, Vaiphei K, Singh K. Colonic polyps: experience of 236 Indian children. Official journal of the American College of Gastroenterology| ACG. 1998 Apr 1;93(4):619-22.
  28. 28. Tringali A, Thomson M, Dumonceau JM, Tavares M, Tabbers MM, Furlano R, et al. Pediatric gastrointestinal endoscopy: European society of gastrointestinal endoscopy (ESGE) and European society for paediatric gastroenterology hepatology and nutrition (ESPGHAN) guideline executive summary. Endoscopy. 2017 Jan;49(01):83-91. doi: 10.1055/s-0042-111002.
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