Colorectal polyps in childhood.
OBJECTIVE
Colorectal polyps are a common cause of gastrointestinal bleeding in children. This review updates the information on colorectal polyps and summarizes the recent advances in genetics, diagnosis, and treatment of polyps in the large intestine.


RESULTS
A review of recent literature regarding colorectal polyps demonstrates an estimated detected prevalence of 6.1% overall and 12.0% among those with lower gastrointestinal bleeding during pediatric colonoscopy. Non-Caucasian races (e.g., black and Hispanic) are at higher risk for colorectal polyps in childhood. Recent data show juvenile polyps may recur in approximately 45% of children with multiple polyps and 17% of children with solitary polyps. A clinical trial showed that celecoxib, a cyclooxygenase (COX)-2 inhibitor, significantly reduced the number of colorectal polyps in children with familial adenomatous polyposis (FAP). Ethical challenges related to genetic tests for FAP have been newly examined. The utility of novel endoscopic techniques (e.g., enteroscopy) in Peutz-Jeghers Syndrome to prevent intussusception have been newly described.


CONCLUSIONS
Although colorectal polyps in children are generally benign and easily removed, careful clinical evaluation and ongoing research are needed to identify the small proportion of children at risk for cancer. The current paradigm of using the polyp number at presentation as a primary determinant of subsequent surveillance may be inadequate for many patients.
The Section of Pediatric Gastroenterology, Hepatology and Nutrition at Texas Children's Hospital, Baylor College of Medicine, Houston, Texas 77030, USA. kthakkar@bcm.tmc.edu
Kalpesh
K
Thakkar
Douglas S
DS
Fishman
Mark A
MA
Gilger
D018256:Adenomatous Polyps / Q000150:complications / Q000453:epidemiology / Q000473:pathology; D000293:Adolescent; D017668:Age of Onset; D000068579:Celecoxib; D002648:Child; D002675:Child, Preschool; D003111:Colonic Polyps / Q000150:complications / Q000453:epidemiology / Q000473:pathology; D015179:Colorectal Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000517:prevention & control; D052246:Cyclooxygenase 2 Inhibitors / Q000627:therapeutic use; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D007223:Infant; D007420:Intestine, Large / Q000473:pathology*; D007443:Intussusception / Q000517:prevention & control; D008297:Male; D010580:Peutz-Jeghers Syndrome / Q000150:complications / Q000453:epidemiology / Q000473:pathology; D015995:Prevalence; D011720:Pyrazoles / Q000627:therapeutic use; D013449:Sulfonamides / Q000627:therapeutic use
D052246:Cyclooxygenase 2 Inhibitors; D011720:Pyrazoles; D013449:Sulfonamides; D000068579:Celecoxib