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Upper gastrointestinal tract bleeding in critically ill pediatric patients
1Department of Clinical Pharmacy, University of Tennessee, Memphis, Center for Pediatric Pharmacokinetics and Therapeutics, USA.
Insights
Physiologic stress in children can cause gastrointestinal tract imbalances, leading to stress ulceration and acute upper gastrointestinal bleeding (UGIB). Understanding these pediatric differences is crucial for effective prevention and treatment.
Area of Science:
- Pediatric Gastroenterology
- Critical Care Medicine
Background:
- Physiologic stress in children disrupts the balance of gastrointestinal defensive and aggressive factors.
- This imbalance can lead to upper gastrointestinal epithelium damage, stress ulceration, and acute upper gastrointestinal bleeding (UGIB).
Purpose of the Study:
- To explore the pathophysiology of stress ulceration and UGIB in children.
- To highlight differences in ulceration development, location, and number compared to adults.
- To discuss the complexities of UGIB prophylaxis and pharmacotherapy in neonates and infants.
Main Methods:
- Review of existing literature on pediatric stress ulceration and UGIB.
- Analysis of factors influencing gastrointestinal tract development and UGIB risk in pediatric populations.
- Discussion of clinical challenges in managing UGIB in children.
Main Results:
- Pathophysiology of UGIB in children shares similarities with adults but presents unique characteristics.
- Factors like disease, age, and enteral feeding influence UGIB development in neonates and infants.
- Pharmacotherapy for UGIB in children is complicated by administration and adverse effect concerns.
Conclusions:
- Pediatric UGIB requires consideration of age-specific factors and developmental status.
- Further research is needed to optimize prevention and treatment strategies for UGIB in vulnerable pediatric populations.
Abstract:
Similar to adults, children under physiologic stress can develop an imbalance in defensive (mucosal layer, motility) and aggressive (gastric acid, bile salts, enzymes) factors responsible for maintaining a healthy gastrointestinal tract. Hypoxia in the gastrointestinal tract likely disrupts the defensive factors, thereby permitting damage by aggressive factors to upper gastrointestinal epithelium that may progress to stress ulceration and acute upper gastrointestinal tract bleeding (UGIB). The basic pathophysiology may be similar in children and adults; however, differences in the time to developing ulceration, ulcer location, and number of ulcers have been reported. Functional development of the gastrointestinal tract is influenced by disease, gestational and postnatal age, and exposure to and type of enteral feedings, thereby confounding the development and prophylaxis of UGIB in neonates and infants. In addition, pharmacotherapy decisions are often complicated by drug administration issues and adverse effects.