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Upper gastro-intestinal tract bleeding in cirrhotic children candidates for liver transplantation
E M Sokal1, N Van Hoorebeeck, L Van Obbergh
1Department of Paediatrics, Université Catholique de Louvain, Cliniques St Luc, Brussels, Belgium.
Insights
In cirrhotic children awaiting liver transplants, iterative sclerotherapy effectively controlled acute variceal bleeding. Ranitidine successfully treated bleeding ulcers, highlighting effective management options for gastrointestinal bleeding in pediatric liver disease.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Transplantation Medicine
Background:
- Portal hypertension is a common complication in cirrhotic children.
- Upper gastrointestinal tract bleeding is a significant risk in this population.
- Effective management is crucial for children awaiting liver transplantation.
Purpose of the Study:
- To evaluate the efficacy of iterative sclerotherapy for variceal bleeding.
- To assess the management of gastrointestinal ulcers in cirrhotic children.
- To determine outcomes of bleeding episodes in pediatric liver disease.
Main Methods:
- Retrospective analysis of 76 cirrhotic children evaluated for liver transplantation.
- Recording of portal hypertension signs and upper gastrointestinal bleeding history.
- Assessment of iterative sclerotherapy for variceal bleeding and ranitidine for ulcers.
Main Results:
- Varices were present in 70% of children; 29% experienced upper GI bleeding.
- Variceal bleeding occurred in 19 patients; ulcers in 3.
- Iterative sclerotherapy controlled variceal bleeding in most cases; ranitidine was effective for ulcers.
Conclusions:
- Iterative sclerotherapy is efficient for controlling acute variceal bleeding in children with end-stage liver disease.
- It also prevents recurrent bleeding in patients awaiting liver replacement.
- Bleeding ulcers are frequent and respond well to H2 histamine receptor antagonists like ranitidine.
Abstract:
Signs of portal hypertension, history of upper gastro-intestinal tract bleeding episodes and outcome of the latter were recorded in 76 cirrhotic children evaluated for liver transplantation. Fifty-three (70%) had varices and 22 (29%) had experienced upper gastro-intestinal tract bleeding. Of these 22, 19 bled from varices and 3 from ulcers. Non bleeding ulcers were also found in five patients bleeding from varices. Iterative sclerotherapy controlled acute variceal bleeding in all but one patient in whom emergency transplantation was performed. Six of the eight patients with ulcers were successfully treated by the H2 histamine receptor antagonist ranitidine. We conclude that iterative sclerotherapy is efficient to control acute variceal bleeding and prevents recurrent bleeding in children with end-stage liver diseases awaiting liver replacement. Bleeding asymptomatic ulcers are frequent and respond to H2 histamine receptor antagonists.