Diagnosis and Management of Upper Gastrointestinal Bleeding in Children

Abstract

Upper gastrointestinal bleeding is an uncommon but potentially serious, life-threatening condition in children. Rapid assessment, stabilization, and resuscitation should precede all diagnostic modalities in unstable children. The diagnostic approach includes history, examination, laboratory evaluation, endoscopic procedures, and imaging studies. The clinician needs to determine carefully whether any blood or possible blood reported by a child or adult represents true upper gastrointestinal bleeding because most children with true upper gastrointestinal bleeding require admission to a pediatric intensive care unit. After the diagnosis is established, the physician should start a proton pump inhibitor or histamine 2 receptor antagonist in children with upper gastrointestinal bleeding. Consideration should also be given to the initiation of vasoactive drugs in all children in whom variceal bleeding is suspected. An endoscopy should be performed once the child is hemodynamically stable. (J Am Board Fam Med 2015; 28:134 -145.)

Analysis of risk factors and development of scoring system to predict severity of upper gastrointestinal bleeding in children

“…The most common causes of UGIB in children have been distinctly reported. Globally, etiology of UGIB differs significantly based on variations in patient population and presence of comorbid conditions . Rafeey et al .…”

Pediatric Gastroduodenal Embolization with a Microvascular Plug

“…Endoscopic intervention is the gold standard in treating UGIB and rebleeding is usually managed with repeat endoscopic intervention. Transcatheter arterial embolization (TAE) is often the next step for persistent hemorrhage [1].…”

Gastrointestinal Bleeding in Children can have Many Causes

“…Many drugs are implicated in neonatal gastrointestinal bleeding. Drugs such as NSAID, cortisone, heparin, indomethacin, aspirin, cephalotin, and phenobarbital cause coagulation abnormalities in neonates [6]. Prematurity, mechanical ventilation, and neonatal distress are all associated with stress gastritis.…”