الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
LGIB refers to bleeding distal to the ligament of Treitz, at the duodeno-jejunal junction. It is a common presenting symptom. The clinical presentation of a child with gastrointestinal hemorrhage can vary from acute life threatening shock to a clinically asymptomatic child with stools that are positive for occult blood.
The most common causes of rectal bleeding are anal fissure, cow’s milk or soy protein-induced colitis, intussusception, infectious gastroenteritis, colorectal polyps, IBD, non-specific colitides and vascular anomalies. Etiologies of this condition vary among different age groups.
The diagnostic possibilities assessed by a focused history and physical examination. Laboratory tests and imaging studies depend on the age group of the patient and the suspected disorder. The gold standard for diagnosis is colonoscopy. Fecal calprotectin is a small calcium-binding protein. It is a cheap noninvasive method. Its concentrations are raised in patients with intestinal mucosal inflammation so could be used as screening tools in patients developing new bowel symptoms and predicting relapse in those with established disease. Therefore, it may be ordered to help determine whether an endoscopy is indicated.
The aim of this study was to detect the usefulness of fecal calprotectin in discrimination of different causes of bleeding per rectum and to evaluate the correlation between the degree of its elevation and the cause of rectal bleeding.
To achieve this goal, the present study included a total of 100 children with BPR, scheduled for colonoscopy at Alexandria University Children’s Hospital. A control group of 50 age and sex-matched healthy children were included.
The main results of the study include the following:
1. Males account for 57% of the BPR children in our series, with a mean age of 75.44 months at diagnosis and in 90% of the cases BMI wasn’t affected by the disease process.
2. Allergic colitis was the commonest cause of bleeding (39%), followed by IBD (37%) and 22% had polyps or polyposis syndrome.
3. Abdominal pain was the most common associated symptom, followed by mucoid diarrhea. Patients with polyps presented with painless rectal bleeding with normal bowel movements.
4. Extraintestinal manifestations, perianal disease and weight loss were more predominant in CD cases when compared to other groups (52.9%, 29.4% and 58.8% respectively).
5. Family history was positive in 20.5% of allergic colitis cases, 20% and 17.6% for UC and CD cases respectively. Family history was positive only in 9% of the patients with polyps.
6. Endoscopically, pancolitis was the most common presentation in all cases of colitis.
7. Elevated fecal calprotectin was the most evident inflammatory laboratory parameter (99%) followed by elevated CRP (39%) and leukocytosis (33%).
8. FCP had significantly higher levels among IBD patients than the other groups (mean level 1044.2±805.1 µg/g for UC, 823.8±515.2 µg/g for CD). The control group has the lowest level (109.6±77.2 µg/g) (P value <0.001).
9. In IBD cases, FCP level was strongly correlated with clinical, endoscopic severity indices and white cell count.
10. A strong positive relation was noted between the increase of FCP level in allergic colitis cases and both endoscopic severity and CRP level.
11. There was a strong positive association between the level of FCP and polyp number and site.
12. A non-significant positive relationship between FCP level and disease duration or frequency of bleeding was found in different groups.
13. There was a statistically significant cut off level of more than 650 µg/g to distinguish IBD cases from other causes of BPR for children more than 4 years.