Explore the vast range of titles available.

We report a case of a 13‐year‐old male who presented to the Pediatric Gastroenterology clinic with complaints of abdominal pain and frequent stooling, worsened by hematochezia. Despite undergoing endoscopic evaluation twice within a 1‐year period, the diagnosis of an Inflammatory Cloacogenic Polyp (ICP) was only revealed during the second evaluation, in which rectal retroflexion was performed. This case highlights the importance of maintaining the ICP at the anorectal transitional zone as part of the differential diagnosis when evaluating patients with symptoms of distal colitis.

Objective: To determine the frequency of different causes of Lower GI bleeding on colonoscopy in younger aged patients. Study type, settings & duration: This prospective, cross-sectional study was conducted at Endoscopy Unit, National Institute of Liver and Gastrointestinal Diseases, Dow University of Health Sciences, Karachi from September 2020 to September 2021.   Methodology: In this study, patients presenting with lower GI bleed who underwent colonoscopy at inpatient, outpatient department and referral cases were asked to participate after obtained informed consent from them. The sampling technique used was consecutive sampling. Results: This study included 197 patients, 106 (53.8%) of whom had hemorrhoids alone, 59 (29.9%) had simultaneous diagnosis of hemorrhoids with other etiology, and 32 (16.2%) had aetiologies besides hemorrhoids. Hemorrhoids caused the most lower gastrointestinal bleeding (53.8%), followed by nonspecific ilietis/colitis (17.8%) and polyps (9.1%). Hemorrhoids affected older people and males more. Hemorrhoids were also more common among married and addict patients as compared to unmarried and non-addicted patients. Haemorrhoids was associated with increased weight loss (39.4% vs. 21.2%, p-value = 0.010) as well as antibiotic usage (35.1% vs. 32.4%, p-value = 0.006). Conclusion: The study reveals a significant association between age, gender, marital status, addiction history, weight loss, and antibiotic usage in the diagnosis and treatment of lower gastrointestinal bleeding.

Acute lower gastrointestinal bleeding (LGIB) is a common reason for hospitalization in the United States and is associated with significant utilization of hospital resources, as well as considerable morbidity and mortality. These revised guidelines implement the Grading of Recommendations, Assessment, Development, and Evaluation methodology to propose recommendations for the use of risk stratification tools, thresholds for red blood cell transfusion, reversal agents for patients on anticoagulants, diagnostic testing including colonoscopy and computed tomography angiography (CTA), endoscopic therapeutic options, and management of antithrombotic medications after hospital discharge. Important changes since the previous iteration of this guideline include recommendations for the use of risk stratification tools to identify patients with LGIB at low risk of a hospital-based intervention, the role for reversal agents in patients with life-threatening LGIB on vitamin K antagonists and direct oral anticoagulants, the increasing role for CTA in patients with severe LGIB, and the management of patients who have a positive CTA. We recommend that most patients requiring inpatient colonoscopy undergo a nonurgent colonoscopy because performing an urgent colonoscopy within 24 hours of presentation has not been shown to improve important clinical outcomes such as rebleeding. Finally, we provide updated recommendations regarding resumption of antiplatelet and anticoagulant medications after cessation of LGIB.

Background: There is insufficient evidence regarding the management of hematochezia after colorectal endoscopic mucosal resection (EMR) without endoscopic hemostasis. Objectives: The aim of this study was to develop an observable score for hematochezia after colorectal EMR. Design: Retrospective study. Methods: This retrospective study included three hospitals in Japan. During the study period, colorectal EMR was performed in 3989 patients (11,414 lesions). Post-EMR hematochezia (delayed bleeding (DB)) was observed in 169 patients (512 lesions). Of these, 47 patients (150 lesions) were classified into the Hemostasis Group, comprising those who underwent endoscopic hemostasis. The remaining 122 (362 lesions) were classified into the non-hemostasis group, comprising those who underwent endoscopy without hemostasis, received preventive hemostasis, and did not undergo emergency endoscopy. Weighted points were assigned to predict observable cases following colorectal EMR through multivariate logistic regression analysis, enabling the development of a predictive model. Results: The prediction model comprised three variables (male gender, American Society of Anesthesiologists Physical Status 3, direct oral anticoagulant). According to the definition, the total score was categorized as lowly observable (2 or 3 points) and highly observable (0 or 1 points) for DB after colorectal EMR. As a result, the rates of observable cases for each risk category were 45.7% and 81.8%, respectively. The model showed good discrimination ability from the c-statistic (95% CI) of 0.71 (0.63–0.79). Conclusion: Although further prospective studies are necessary to validate the utility of the score, it may be useful in clinical practice.

Comparing two bowel cleansing volumes for patients with hematochezia who need a colonoscopy Hematochezia, which means passing bright red blood from the bowel, is a common reason for people to seek medical care. When this happens, doctors usually recommend a colonoscopy to find the cause of bleeding and provide treatment. To perform a safe and accurate colonoscopy, the bowel must be properly cleaned. However, drinking large amounts of cleansing solution is often uncomfortable, especially for people who are already unwell. This study examined whether a smaller amount of bowel cleansing solution could work as well as a larger amount in patients with hematochezia. We compared two cleansing regimens: a 1-liter solution and a 2-liter solution. Our main goal was to learn whether the smaller amount would clean the bowel well enough for doctors to clearly see the inside of the colon. We also evaluated how patients felt while taking the solution and whether any side effects occurred. We conducted a randomized clinical study at two hospitals. Adults with hematochezia were assigned to drink either the 1-liter or the 2-liter solution before their colonoscopy. We measured bowel cleanliness, the ability of doctors to identify the bleeding source, patient comfort and willingness to repeat the same preparation, and any safety concerns. The study included 184 patients. Overall, the 1-liter solution cleaned the bowel just as well as the 2-liter solution. In some parts of the colon, especially the transverse and left segments, the 1-liter solution even performed slightly better. Both groups had similar success in identifying the source of bleeding, and no serious side effects were found. Many patients found the smaller-volume preparation easier and more comfortable to take. These results suggest that a 1-liter preparation is an effective and safe option for people with hematochezia who need a colonoscopy. A smaller amount may improve comfort without reducing the quality of the examination.

Cow’s milk protein allergy (CMPA) is the commonest food allergy in infancy and is associated with significant health burden. Given their immune modulatory properties, probiotics have been proposed as a strategy for management of CMPA. We aimed to systematically review efficacy and safety of probiotics in the management of CMPA. Databases PubMed, EMBASE, CINAHL, Cochrane Central Library, and Google scholar were searched in August 2018 for randomized controlled trials (RCT) of probiotic supplementation as an adjunct in the management of infants with suspected/proven CMPA. Primary outcomes were resolution of hematochezia and acquisition of tolerance to CMP at 6, 12, 24, and 36 months. Secondary outcomes included effect on allergic symptoms (SCORAD index), growth, gut microbiota, and adverse effects. A total of 10 RCTs (n = 845; probiotics, 422; control, 423) with low to unclear risk of bias were included. Meta-analysis showed probiotic supplementation was not associated with earlier resolution of hematochezia (n = 87; RR: 1.45 (95% CI: 0.96–2.18), p = 0.08; level of evidence (LOE), very low), in presumed CMPA. In confirmed CMPA, probiotics were associated with higher rate of acquisition of tolerance to CMP at the end of 3 years compared with placebo (N = 493; RR, 1.47; 95% CI, (1.17–1.84); p = 0.0009; LOE, low]. Meta-analysis was not possible for other outcomes. There were no probiotic related adverse effects.Conclusion: Limited low-quality evidence indicates that probiotic supplementation may be associated with earlier acquisition of tolerance to CMP in children with CMPA. Large well-designed trials are essential to confirm these findings.What is Known:• Cow’s milk protein allergy (CMPA) is one of the commonest food allergies in children. CMPA is associated with significant socioeconomic burden.• Elimination diet and extensively hydrolyzed formula is the mainstay of the management of CMPA.What is New:• This first systematic review of randomized controlled trials shows that probiotics as an adjuvant can lead to earlier acquisition of tolerance to CMP in children at 36 months of age. However, the evidence is low quality and influenced by data from one large study.• Probiotic supplementation was not associated with earlier resolution of hematochezia.

Background: Colonoscopy is the gold standard procedure which is widely used in the diagnosis and treatment of colonic mucosal disorder. Colonoscopy examination which is included in the referral system of the social insurance administration organization has been available at St Vincentius Hospital Singkawang since March 2017 to support diagnosis of lower gastrointestinal diseases. Patients were from Singkawang City and 3 surrounding districts (Sambas, Bengkayang, and Mempawah) that close to the Malaysian border. The purpose of this study is to evaluate symptom and diagnosis yield of patient who underwent colonscopy at St. Vincentius Hospital, Singkawang from March 2017 to April 2018. Method: This was a retrospective descriptive study by using secondary data of patient’s medical records at St Vincentius Hospital Singkawang in March 2017 - April 2018. Every patient is included as a sample (total sampling). Results: Total numbers are consisted 78 colonoscopies, with 163 cases of lower gastrointestinal disease. Three major findings of colonoscopy were internal hemorrhoids (64%), colon mass (30%), and inflammatory bowel disease (IBD) (26%). Indications of patient to underwent colonoscopy were hematochezia 38%, chronic diarrhea 19%, chronic constipation 18%, anemia 12%, abdominal pain 6%, screening neoplasia 3% and unexplained weight lost 3%. Conclusion: Hematochezia is the most common indication of patients to underwent colonoscopy at Singkawang and its surrounding districts. The most common finding of colonoscopy was hemorrhoid.