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2017 ; 4
(11
): ä Nephropedia Template TP
gab.com Text
Twit Text FOAVip
Twit Text #
English Wikipedia
Upper Gastrointestinal Bleeding in Children: A Tertiary United Kingdom Children s
Hospital Experience
#MMPMID29099778
Nasher O
; Devadason D
; Stewart RJ
Children (Basel)
2017[Nov]; 4
(11
): ä PMID29099778
show ga
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.
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