Causes of hematochezia and hemorrhagic antibiotic-associated colitis in children and adolescents

Laura Stampfer, Andrea Deutschmann, Elisabeth Dür, Franz G Eitelberger, Theresia Fürpass, Gregor Gorkiewicz, Peter Heinz-Erian, Ingrid Heller, Kathrin Herzog, Barbara Hopfer, Reinhold Kerbl, Evelyn Klug, Robert Krause, Eva Leitner, Christoph Mache, Thomas Müller, Jasmin Pansy, Mirjam Pocivalnik, Eva Scheuba, Georg Schneditz, Gerolf Schweintzger, Edith Sterniczky, Ellen Zechner, Almuthe C Hauer, Christoph Högenauer, Karl Martin Hoffmann
Medicine (Baltimore) 2017, 96 (33): e7793
Diseases causing hematochezia range from benign to potentially life-threatening. Systematic pediatric data on the causes of hematochezia are scarce. We studied the underlying causes and long-term outcome of hematochezia in children. We further investigated the relevance of antibiotic-associated hemorrhagic colitis in children, especially if caused by Klebsiella oxytoca.Infants, children, and adolescents with hematochezia were recruited prospectively. Patients were grouped according to age (<1 year, 1-5 years, 6-13 years, >14 years). In addition to routine diagnostics, K oxytoca stool culture and toxin analysis was performed. We collected data on history, laboratory findings, microbiological diagnostic, imaging, final diagnosis, and long-term outcome.We included 221 patients (female 46%; age 0-19 years). In 98 (44%), hematochezia was caused by infectious diseases. Endoscopy was performed in 30 patients (13.6%). No patient died due to the underlying cause of hematochezia. The most common diagnoses according to age were food protein-induced proctocolitis in infants, bacterial colitis in young children, and inflammatory bowel disease in children and adolescents. Seventeen (7.7%) had a positive stool culture for K oxytoca. Antibiotic-associated colitis was diagnosed in 12 (5%) patients: 2 caused by K oxytoca and 2 by Clostridium difficile; in the remaining 8 patients, no known pathobiont was identified.Infections were the most common cause of hematochezia in this study. In most patients, invasive diagnostic procedures were not necessary. Antibiotic-associated hemorrhagic colitis caused by K oxytoca was an uncommon diagnosis in our cohort. Antibiotic-associated colitis with hematochezia might be caused by pathobionts other than C difficile or K oxytoca.

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