Document Type : Original Article
Authors
1 Department of Pediatrics, Division of Pediatric Gastroenterology, Health Sciences University, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
2 Department of Pediatrics, Division of Pediatric Gastroenterology, Health Sciences University, Zeynep Kamil Maternity and Children’s Training and Research Hospital, Istanbul, Turkey
3 Department of Pediatrics, Division of Pediatric Gastroenterology, Health Sciences University, Bakırköy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
Abstract
Objective: Upper gastrointestinal bleeding (UGB) is one of the most important and serious cause of emergency admission in childhood. The aim of the study was to evaluate the etiological factors and the treatment approaches in patients with UGB.
Methods: In this retrospective study, children with UGB admitted to emergency clinics of Istanbul Health Sciences University Kanuni Sultan Suleyman Research and Training Hospital, Istanbul Bakirkoy Sadi Konuk Research and Training Hospital and Diyarbakir Children’s Hospital were evaluated between January 2014 and August 2017.
Results: Of the 198 children, 14.6% had non-steroid anti-inflammatory drug (NSAID) history, and 12.6% had chronic liver disease. We detected esophagitis, esophagus varices and peptic ulcer with upper gastrointestinal endoscopic evaluation (47%, 11.1%, 18.1%, respectively). Helicobacter pylori was found in 61.6% of patients. Endoscopic therapeutic procedures (band ligation therapy, sclerotherapy, and adrenaline injection) were appied in 11.1% of patients. Eighty-four (42.4%) patients were hospitalized, and erythrocyte transfusion (ET) was ordered in 29 (14.6%) patients.
Conclusion: Approximately in 20% of the pediatric patients, the source of gastrointestinal bleeding is the upper gastrointestinal system. The cause of UGB varies with age. Appropriate diagnostic and therapeutic approaches are very important for management and to reduce mortality.
Keywords
Main Subjects
2. 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: 831-7. doi: 10.1007/s00228-010-0832-3.
3. Colle I, Wilmer A, Le Moine O, Debruyne R, Delwaide J, Dhondt E, et al. Upper gastrointestinal tract bleeding management: Belgian guidelines for adults and children. Acta Gastroenterol Belg 2011; 74: 45-66.
4. 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. doi: 10.3122/jabfm.2015.01.140153.
5. 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. doi: 10.3748/wjg.v23.i8.1328.
6. Banc-Husu AM, Ahmad NA, Chandrasekhara V, Ginsberg GG, Jaffe DL, Kochman ML, et al. Therapeutic endoscopy for the control of nonvariceal upper gastrointestinal bleeding
in children: a case series. J Pediatr Gastroenterol Nutr 2017;64(4): e88-e91. doi: 10.1097/mpg.0000000000001457.
7. 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. doi: 10.1055/s-0042-111002.
8. Jafari SA, Kiani MA, Kianifar HR, Mansooripour M, Heidari E, Khalesi M. Etiology of gastrointestinal bleeding in children referred to pediatric wards of Mashhad hospitals, Iran. Electron Physician 2018; 10(2): 6341-5. doi:10.19082/6341.
9. Gimiga N, Olaru C, Diaconescu S, Miron I, Burlea M. Upper gastrointestinal bleeding in children from a hospital center of Northeast Romania. Minerva Pediatr 2016; 68(3):
189-95.
10. Cleveland K, Ahmad N, Bishop P, Nowicki M. Upper gastrointestinal bleeding in children: an 11-year
retrospective endoscopic investigation. World J Pediatr 2012; 8(2): 123-8. doi: 10.1007/s12519-012-0350-8.
11. Kalyoncu D, Urganci N, Cetinkaya F. Etiology of upper gastrointestinal bleeding in young children. Indian J Pediatr 2009; 76(9): 899-901. doi: 10.1007/s12098-009-0195-x.
12. Gultekingil A, Teksam O, Gulsen HH, Ates BB, Saltik- Temizel IN, Demir H. Risk factors associated with clinically significant gastrointestinal bleeding in pediatric ED. Am J Emerg Med 2018; 36(4): 665-8. doi: 10.1016/j.ajem.2017.12.022.
13. Mouterde O, Hadji S, Mallet E, Le Luyer B, Métayer P. Les hémorragies digestives chez l’enfant: a propos de 485endoscopies. Ann Pediatr (Paris) 1996; 43(3): 167-76.
14. Usta M, Urganci N. Upper gastrointestinal bleeding in children: the role of helicobacter pylori infection and nonsteroidal anti-inflammatory drug use. West Indian MedJ 2015; 64(2): 113-6.
15. Singhi S, Jain P, Jayashree M, Lal S. Approach to a child with upper gastrointestinal bleeding. Indian J Pediatr 2013;80(4): 326-33. doi: 10.1007/s12098-013-0987-x.
16. Kim SJ, Oh SH, Jo JM, Kim KM. Experiences with endoscopic interventions for variceal bleeding in children with portal hypertension: a single center study. Pediatr Gastroenterol Hepatol Nutr 2013; 16(4): 248-53. doi:10.5223/pghn.2013.16.4.248.
17. Nasher O, Devadason D, Stewart RJ. Upper gastrointestinal bleeding in children: a tertiary united kingdom children’s hospital experience. Children (Basel) 2017; 4(11). doi:10.3390/children4110095.
18. Zheng W, Jiang L, Jia X, Long G, Shu X, Jiang M. Analysis of risk factors and development of scoring system to predict severity of upper gastrointestinal bleeding in children. J Gastroenterol Hepatol 2019; 34(6): 1035-41. doi: 10.1111/jgh.14548.
19. Attard TM, Miller M, Pant C, Kumar A, Thomson M. Mortality associated with gastrointestinal bleeding in children: a retrospective cohort study. World J Gastroenterol 2017; 23(9): 1608-17. doi: 10.3748/wjg.v23.i9.1608.
)