title: Gastrointestinal manifestations as initial presentation of acute leukemias in children and adolescents.
abstract: OBJECTIVE
  this study aimed to determine the prevalence and characteristics of gastrointestinal manifestations on initial clinical presentation of acute leukemias (AL) in childhood.
  
  
  METHODS
  this is a retrospective and descriptive study that assessed medical records of 354 patients with AL from January 1995 to December 2004.
  
  
  RESULTS
  acute lymphoid leukemia (ALL) was diagnosed in 273 (77.1%) patients and acute non-lymphocytic leukemia (AML) in 81 (22.9%). There were 210 males (59.4%) and 144 females (40.6%). The most common presenting features were: abdominal pain (19.5% in ALL and 11.8% in AML), nausea and vomiting (14.9 in ALL and 14% in AML), abdominal distention (18.5 in ALL and 8.6% in AML; p 0.024), constipation (5% in ALL and 6.5% in AML), diarrhea (3.6% in ALL and 11.8% in AML; p 0.03%), and gastrointestinal bleeding (7.9% in ALL and 9.7% in AML). Ultrasound scanning was made in 61.1% and hepatomegaly was found on 33.6% and esplenomegaly on 28.5% of the patients with AL. Seventy-seven (21.7%) and 15 (4.2%) patients received nonsteroidal anti-inflammatory drugs and glucocorticoids before the diagnostic of AL. An association is well-defined between abdominal symptoms like nausea, vomiting and pain and use of this therapy but this association did not occurred clearly in this study.
  
  
  CONCLUSIONS
  gastrointestinal symptoms are not very well-documented as initial manifestation of leukemia in children and should be considered on the differential diagnosis of gastrointestinal symptoms of unknown etiology in children.
authors.affiliation: Department of Pediatric of Federal University of Bahia, Brazil. trobazzi@gmail.com
authors.forename: Teresa C M V
authors.initials: TC
authors.lastname: Robazzi
authors.forename: Luciana R
authors.initials: LR
authors.lastname: Silva
authors.forename: Núbia
authors.initials: N
authors.lastname: Mendonça
authors.forename: José H S
authors.initials: JH
authors.lastname: Barreto
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005767:Gastrointestinal Diseases / Q000209:etiology*; D006801:Humans; D007223:Infant; D015470:Leukemia, Myeloid, Acute / Q000097:blood / Q000150:complications*; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000097:blood / Q000150:complications*; D012189:Retrospective Studies