Upper Gastrointestinal Bleeding in Children: A Tertiary United Kingdom Children's Hospital Experience.

Omar Nasher,Richard Stewart,David Devadason

doi:10.3390/children4110095

Abstract

The aim of this study was to review the aetiology, presentation and management of these patients with upper gastrointestinal bleeding (UGIB) at a tertiary children’s unit in the United Kingdom. This was a retrospective single-institution study on children (<16 years) who presented with acute UGIB over a period of 5 years using known International Classification of Diseases (ICD) codes. A total of 32 children (17 males, 15 females) were identified with a total median age at presentation of 5.5 years. The majority (24/32) of patients presented as an emergency. A total of 19/32 presented with isolated haematemesis, 8/32 with isolated melaena and 5/32 with a combination of melaena and haematemesis. On admission, the mean haemoglobin of patients who presented with isolated haematemesis was 11 g/dL, those with isolated melaena 9.3 g/dL and those with a combination 7.8 g/dL. Blood transfusion was required in 3/19 with haematemesis and 3/5 with haematemesis and melaena. A total of 19/32 underwent upper gastrointestinal endoscopy. Endoscopic findings were oesophageal varices (5/19) of which 4 required banding; bleeding gastric ulcer (1/19) requiring clips, haemospray and adrenaline; gastric vascular malformation (1/19) treated with Argon plasma coagulation therapy; duodenal ulcer (3/19) which required surgery in two cases; oesophagitis (5/19); and gastritis +/− duodenitis (3/19). A total of 13/32 patients did not undergo endoscopy and the presumed aetiology was a Mallory–Weiss tear (4/13); ingestion of foreign body (2/13); gastritis (3/13); viral illness (1/13); unknown (2/13). While UGIB is uncommon in children, the morbidity associated with it is very significant. Melaena, dropping haemoglobin, and requirement for a blood transfusion appear to be significant markers of an underlying cause of UGIB that requires therapeutic intervention. A multi-disciplinary team comprising gastroenterologists and surgeons is essential.

Highlights

Upper gastrointestinal bleeding (UGIB) is infrequent in children, with an estimated incidence of 1–2/10,000 per year [1], of which the majority are benign and self-limiting [2]
A total of 19 (59.3%) patients presented with isolated haematemesis, 8 (25%) with isolated melaena and 5 (15.6%) with a combination of melaena and haematemesis
The mean haemoglobin (Hb) of patients who presented with isolated haematemesis was 11 g/dL, those with isolated melaena had a mean Hb level of 9.3 g/dL and those presenting with a combination of haematemesis and melaena had a mean Hb of 7.8 g/dL

Summary

Introduction

Upper gastrointestinal bleeding (UGIB) is infrequent in children, with an estimated incidence of 1–2/10,000 per year [1], of which the majority are benign and self-limiting [2]. Significant UGIB is exceptional and may pose a challenge to clinicians. The aetiology of UGIB in children is heterogeneous and the exact cause varies with age, co-existing disease and geographical location [3,4]. Common causes include swallowed maternal blood and milk protein allergy, whereas in infants more common aetiologies are Mallory–Weiss tear and reflux oesophagitis. In older children and adolescents, significant causes of gastrointestinal haemorrhage. Children 2017, 4, 95 include variceal bleeding secondary to portal hypertension, and peptic ulceration secondary to stress or mechanical trauma following foreign body ingestion [4].

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