Original Article

Gastrointestinal Tract Bleeding in Intellectually Disabled Adults

Authors: Kamran Khalid, FCPS, FRCSI, FRCSEd, Saleh M. Al-Salamah, FRCS, Ibrahim Al-Teimi, MBBS, FACHARZT, Nasser Faleh Al-Dossary, MBBS, MD

Abstract

Background: Gastrointestinal (GI) tract bleeding in intellectually disabled (ID) individuals presents peculiar diagnostic and management difficulties. This study details the experience of a tertiary referral teaching hospital in Central Saudi Arabia in the management of GI bleeding necessitating admission in ID adults.


Patients and Methods: Prospective collection of data was taken on consecutive ID adults admitted for GI bleeding from January 2000 through December 2004. Demographic details, clinical presentation, diagnosis, associated physical and neurologic disabilities, etiology of bleeding and treatment outcome were analyzed.


Results: Thirty-nine ID adults accounted for 44 admissions during the period under review. Twenty-six (66.7%) patients were admitted with upper, and 13 (33.3%) for lower GI bleeding. Reflux esophagitis (57.7%) remained the most common cause of upper GI bleeding. Five out of 26 patients with upper and 6 of 13 with lower GI bleeding needed operative treatment. Various congenital anomalies or malformations were observed frequently associated with lower GI bleeding.


Conclusions: Bleeding GERD remained the most common etiology of upper GI bleeding necessitating admission. Endoscopy is the mainstay in diagnosis and initial management of ID patients. Continued surveillance endoscopy is recommended for early diagnosis of Barrett changes. Bleeding from developmental malformations may have association with intellectual disability.


Key Points


* Twenty-six (66.7%) intellectually disabled (ID) adults were managed with upper and 13 (33.3%) for lower gastrointestinal (GI) tract bleeding.


* There was marked male preponderance.


* Reflux esophagitis was the most common cause of recurrent upper GI bleeding necessitating admission, and 13% patients with reflux esophagitis had Barrett esophagus.


* Various congenital anomalies or malformations had frequent association with lower GI bleeding.


* Endoscopy remains the mainstay in diagnosis and initial management of ID patients.

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