Non - variceal upper gastrointestinal bleeding in children
Article Sidebar
Main Article Content
Abstract
Introduction: Upper gastrointestinal bleeding in children can occur from infancy through adolescence. While most cases are mild, some may present with severe bleeding, requiring urgent diagnosis and treatment. It is, therefore, crucial for general practitioners and pediatricians to accurately diagnose the underlying cause and provide appropriate initial management.
Objective: To review the current knowledge on non - variceal upper gastrointestinal bleeding in children, with a focus on etiologies, diagnoses, pharmacological treatments, and the evolving techniques for hemostatic interventions. This review aims to provide insights that will benefit the management of pediatric patients with upper gastrointestinal bleeding.
Method of study: Review article
Results: Non-variceal upper gastrointestinal bleeding in children has various causes that differ by age group. Diagnosis can be made through history taking and physical examination. Vital signs should be initially assessed to ensure prompt and appropriate treatment. Currently, the administration of suitable acid-reducing medications is employed, along with upper gastrointestinal endoscopy to identify the cause. Modern hemostatic techniques have also been developed, improving the treatment efficacy and reducing the risks of surgical intervention.
Conclusion: Upper gastrointestinal bleeding in children is an urgent condition that requires prompt diagnosis and treatment, particularly in patients with abnormal vital signs. Currently, diagnosis and hemostatic management can be effectively achieved through upper gastrointestinal endoscopy. It is essential to differentiate the causes of upper gastrointestinal bleeding between non-variceal conditions and those related to varices to ensure appropriate medication use and hemostatic intervention.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
References
Owensby S, Taylor K, Wilkins T. Diagnosis and management of upper gastrointestinal bleeding in children. J Am Board Fam Med 2015;28(1):134-45.
Romano C, Oliva S, Martellossi S, Miele E, Arrigo S, Graziani MG, et al. Pediatric gastrointestinal bleeding: perspectives from the Italian society of pediatric gastroenterology. World J Gastroenterol 2017;23(8):1328-37.
Grimaldi-Bensouda L, Abenhaim L, Michaud L, Mouterde O, Jonville-Béra AP, Giraudeau B, et al. Clinical features and risk factors for upper gastrointestinal bleeding in children: a case-crossover study. Eur J Clin Pharmacol 2010;66(8):831-7.
Lirio RA. Management of upper gastrointestinal bleeding in children: variceal and nonvariceal. Gastrointest Endosc Clin N Am 2016;26(1):63-73.
Khilnani P, Rawal N, Singha C. Gastrointestinal issues in critically ill children. Indian J Crit Care Med 2020;24 Suppl 4:S201-4.
Polat E, Bayrak NA, Kutluk G, Civan HA. Pediatric upper gastrointestinal bleeding in children: etiology and treatment approaches. Journal of Emergency Practice and Trauma 2020;6(2):59-62.
Piccirillo M, Pucinischi V, Mennini M, Strisciuglio C, Iannicelli E, Giallorenzi MA, et al. Gastrointestinal bleeding in children: diagnostic approach. Ital J Pediatr 2024;50(1):13.
Sur LM, Armat I, Sur G, Tisa IB, Bordea MA, Lupan I, et al. Practical aspects of upper gastrointestinal bleeding in children. J Clin Med 2023;12(8):2921.
Kocic M, Rasic P, Marusic V, Prokic D, Savic D, Milickovic M, et al. Age-specific causes of upper gastrointestinal bleeding in children. World J Gastroenterol 2023;29(47):6095-110.
Rosen R, Vandenplas Y, Singendonk M, Cabana M, DiLorenzo C, Gottrand F, et al. Pediatric gastroesophageal reflux clinical practice guidelines: joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr 2018;66(3):516-54.
Kleinman RE, Goulet OJ, Mieli-Vergani G, Sanderson IR, Sherman PM, Shneider BL. Walker's pediatric gastrointestinal disease: physiology, diagnosis, management. 6thed. Raleigh: People's medical publishing house-USA; 2018.
Kessel B, Olsha O, Younis A, Daskal Y, Granovsky E, Alfici R. Evaluation of nasogastric tubes to enable differentiation between upper and lower gastrointestinal bleeding in unselected patients with melena. Eur J Emerg Med 2016;23(1):71-3.
Gong EJ, Hsing LC, Seo HI, Seo M, Jun BG, Park JK, et al. Selected nasogastric lavage in patients with nonvariceal upper gastrointestinal bleeding. BMC Gastroenterol 2021;21(1):113.
Gené E, Calvet X. Nasogastric intubation in patients with upper gastrointestinal bleeding?. Gastroenterol Hepatol 2016;39(8):497-9.
Laine L, Barkun AN, Saltzman JR, Martel M, Leontiadis GI. ACG clinical guideline: upper gastrointestinal and ulcer bleeding. Am J Gastroenterol 2021;116(5):899-917.
Gralnek IM, Stanley AJ, Morris AJ, Camus M, Lau J, Lanas A, et al. Endoscopic diagnosis and management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH): European Society of Gastrointestinal Endoscopy (ESGE) guideline - update 2021. Endoscopy 2021;53(3):300-32.
Villanueva C, Colomo A, Bosch A, Concepcion M, Hernandez-Gea V, Aracil C, et al. Transfusion strategies for acute upper gastrointestinal bleeding. N Engl J Med 2013;368(1):11-21.
Jairath V, Kahan BC, Gray A, Doré CJ, Mora A, James MW, et al. Restrictive versus liberal blood transfusion for acute upper gastrointestinal bleeding (TRIGGER): a pragmatic, open-label, cluster randomised feasibility trial. Lancet 2015;386(9989):137-44.
Kim JS, Kim BW, Kim DH, Park CH, Lee H, Joo MK, et al. Guidelines for nonvariceal upper gastrointestinal bleeding. Gut Liver 2020;14(5):560-70.
Herszenyi L, Bakucz T, Barabas L, Tulassay Z. Pharmacological approach to gastric acid suppression: past, present, and future. Dig Dis 2020;38(2):104-11.
Neidich GA, Cole SR. Gastrointestinal bleeding. Pediatr Rev 2014;35(6):243-54.
Thomson M, Tringali A, Dumonceau JM, Tavares M, Tabbers MM, Furlano R, et al. Paediatric gastrointestinal endoscopy: European Society for Paediatric Gastroenterology Hepatology and Nutrition and European Society of Gastrointestinal Endoscopy guidelines. J Pediatr Gastroenterol Nutr 2017;64(1):133-53.
Tringali A, Thomson M, Dumonceau JM, Tavares M, Tabbers MM, Furlano R, et al. Pediatric gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) and European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) guideline executive summary. Endoscopy 2017;49(1):83-91.
Poddar U. Diagnostic and therapeutic approach to upper gastrointestinal bleeding. Paediatr Int Child Health 2019;39(1):18-22.
Gralnek IM, Dumonceau JM, Kuipers EJ, Lanas A, Sanders DS, Kurien M, et al. Diagnosis and management of nonvariceal upper gastrointestinal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy 2015;47(10):a1-46.
Kay MH, Wyllie R. Therapeutic endoscopy for nonvariceal gastrointestinal bleeding. J Pediatr Gastroenterol Nutr 2007;45(2):157-71.
Xavier AT, Campos JF, Robinson L, Lima EJM, da Rocha LCM, Arantes VN. Endoscopic clipping for gastrointestinal bleeding: emergency and prophylactic indications. Ann Gastroenterol 2020;33(6):563-70.
Thomson MA, Leton N, Belsha D. Acute upper gastrointestinal bleeding in childhood: development of the Sheffield scoring system to predict need for endoscopic therapy. J Pediatr Gastroenterol Nutr 2015;60(5):632-6.
Yucel A. Evaluation of the Sheffield score, clinical characteristics, and the therapeutic approach in children with upper gastrointestinal system bleeding. Eur Rev Med Pharmacol Sci 2022;26(21):7986-95.
