Spectrum of upper gastrointestinal bleed in children

  • Sadhana R. Zope
  • Radha G. Ghildiya
  • Prachi S. Karnik
Keywords: Gastrointestinal haemorrhage, Oesophagogastroduodenoscopy, EHPVO, Oesophageal varices, Septicaemia, Sclerotherapy.


Aims and Objectives: To study the etiology, occurrence and pattern of upper gastrointestinal haemorrhage and investigations this would aid in the early diagnosis and management of children with upper gastrointestinal haemorrhage.

Methods: This study was conducted over two years on 50 children below 12 years of age who presented with upper gastrointestinal bleeding, at a tertiary care hospital. All the cases were analysed by taking a detailed history and examination. An oesophagogastroduodenoscopy was done in indicated cases. The patients were treated according to standard guidelines and were followed up for a period of two year. Bleeding control was assessed during follow up based on check scopy findings.

Results: The majority of children who presented with upper gastrointestinal bleedwere in the age group of 6-10 years with male predominance with male to female ratio being 1.3:1. EHPVO was the most common cause. Among 15 cases of EHPVO, 12 required endoscopic interventions, with recurrent bleed in 3 patients (25%). Oesophageal varices were the commonest finding seen on endoscopy. Of the 14 patients (66.6%) who followed for check scopy, 78.5 % showed no bleed on follow up and 21.5% showed small varices not requiring any intervention. The mortality was 26% (13) in patients with UGIB. Patients who had an underlying hepatic failure and septicaemia had higher mortality as compared to other patients. Conclusion: The outcome of children with EHPVO depends on the control of bleeding. Sclerotherapy and banding are effective in long-term variceal bleeding control. EHPVO was associated with better outcome inpatients with UGIB.


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. Rafeey M, Khalafi J. Available from: URL: http://medicaljournal.tbzmed.ac.ir/PDF/bahar%2085/eng/10.pdf.Accessed on Dec 7 2010.

. Heitlinger LA, McClung HJ. Gastrointestinal hemorrhage. In: Wyllie R, Hayms JS eds. Pediatric Gastrointestinal Disease. Pathophysiology, Diagnosis, and Management, 2nd edn. Philadelphia, WB Saunders; 1999: 64-72.

. Okello TR. Upper gastrointestinal endoscopic findings in adolescents at Lacor hospital, Uganda Afr Health Sci 2006; 6(1): 39-42.

. Fleisher G, Ludwig S, ed. Gastrointestinal bleeding. Pediatric Emergency Medicine, 4th ed. Philadelphia: Lippincott Williams and Wilkins; 2000; 30:275-282.

. Hirschowitz BI. Development and application of endoscopy. Gastroenterology 1993; 104:337-42.

. Dehghani SM, Haghighat M, Imanich MH, Tabebordbar MR. Upper Gastrointestinal Bleeding in Children in Southern Iran. Indian Journal of Pediatrics 2009; 76:635-638.

. Zahavi I, Arnon R, Ovadia B, Rosenbach Y, Hirsch A, Dinari G. Upper gastrointestinal endoscopy in the pediatric patient. Isr J Med Sci 1994; 67-69.

. Mittal SK, Kalra KK, Aggarwal V. Diagnostic upper GI endoscopy for hemetemesis in children: experience from a pediatric gastroenterology centrein north India. Indian J Pediatr1994; 61: 651-654.

. Dass R, Barman H, Duwarah SG, Deka NM, Jain P and Choudhury V. Unusual Presentations of Malaria in Children: An Experience from a Tertiary Care Centre in orth East India. Indian J Pediatr 2010; 77(6):655-660.

. Hussey S, Kelleher K, Ling SC. Prospective study of major upper gastrointestinal haemorrhage in children. Clinical Pediatric Emergency Medicine; 11; 207-16.

. Aftab R, Iqbal I. Fulminant hepatic failure in children clinical features, etiology and outcome analysis. Pak Paed J 2007; 31(4):195-200.

. Patrawala V, Das HS, Sawant P, Rathi P, Vyas K, Dhad Phale S,et al. A long term post sclerotherapy follow up of EHPVO children with upper gastrointestinal haemorrhage. Bombay Hospital Journal. 2001; 43(4): 514-7.

. Poddar U, Thapa BR, Prasad A, Sharma AK, Singh K. Natural history and risk factor in fulminant hepatic failure. Arch Dis Child 2002; 87: 54-6.

. Leca E, Grimaldi BL, Maurage C, Jonville-Bera AP. Upper gastrointestinal complications associated with NSAIDs in children. Therapie. 2007; 62(2):173-6.

. Kalyoncu D, Urganci N, Cetinkaya F. Etiology of Upper Gastrointestinal Bleeding in Young Children. Indian Journal of Pediatrics 2009; 27:899-901.

. Li Voti G, Acierno C, Tulone V. Relationship between upper gastrointestinal bleeding and nonsteroidal antiinflammatory drugs in children. Pediatric Surg Int 1997; 12: 264-265.

. Huang IF, Wu TC, Wang KS. Upper gastrointestinal endoscopy in children with upper gastrointestinal bleeding. J Chin Med Assoc2003; 66: 271-275.

. Yachha SK, Khanduri A, Sharma BC, Kumar M. Gastrointestinal bleeding in children. J Gastroenterol Hepatol 1996; 11:903.

. Bendre SV, Bavdekar AR, Bhave SA, Pandit AN, Chitambar SD, Arankalle VA, et al. Fulminant hepatic failure: Etiology, viral markers and outcome. Indian Paediatr 1999; 36: 1107-12.

. Lee WS, McKiernan P, Kelly DA et al. Etiology, outcome and prognostic indicators of childhood fulminant hepatic failure in the United Kingdom. J pediatric gastroenterol Nutr. 2005; 40(5): 575-81.

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