title: Gastrointestinal tract bleeding in intellectually disabled adults.
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.
  
  
  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.
authors.affiliation: College of Medicine, and Department of General Surgery Medicine, King Saud University Unit, Riyadh Medical Complex, Riyadh, Saudi Arabia. kkkhawaja@rcsed.ac.uk
authors.forename: Kamran
authors.initials: K
authors.lastname: Khalid
authors.forename: Saleh M
authors.initials: SM
authors.lastname: Al-Salamah
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Al-Teimi
authors.forename: Nasser Faleh
authors.initials: NF
authors.lastname: Al-Dossary
mesh_terms: D000293:Adolescent; D000328:Adult; D015897:Comorbidity; D016099:Endoscopy, Gastrointestinal; D004942:Esophagitis, Peptic / Q000150:complications; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D006801:Humans; D008297:Male; D019989:Persons with Intellectual Disabilities; D011446:Prospective Studies; D054328:Proton Pump Inhibitors; D012008:Recurrence
chemical_list: D054328:Proton Pump Inhibitors