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Age-specific causes of upper gastrointestinal bleeding in children
Marija Kocic1, Petar Rasic2, Vuk Marusic3
1Department of Gastroenterology, Hepatology and Nutrition, Mother and Child Health Care Institute of Serbia "Dr. Vukan Cupic", Belgrade 11000, Serbia.
Insights
Upper gastrointestinal bleeding (UGIB) causes vary by age and region, requiring tailored diagnosis and treatment. Understanding these variations is key for effective clinical management and rapid therapy initiation.
Area of Science:
- Pediatric Gastroenterology
- Internal Medicine
- Clinical Diagnostics
Background:
- Upper gastrointestinal bleeding (UGIB) etiology is diverse, influenced by patient age, geographic location, and specific clinical settings.
- Causes range from age-specific conditions like vitamin K deficiency in neonates to common issues like erosive esophagitis and gastritis across all ages.
- Global incidence and common causes of UGIB show regional variations, with Western countries predominantly seeing non-variceal causes, while variceal bleeding remains prevalent in parts of South Asia.
Purpose of the Study:
- To elucidate the age-dependent and geographically variable etiologies of upper gastrointestinal bleeding (UGIB).
- To emphasize the importance of recognizing specific UGIB causes for accurate diagnosis and timely therapeutic intervention.
- To highlight the diagnostic and therapeutic roles of endoscopy in managing UGIB.
Main Methods:
- Review of existing literature on the causes and management of upper gastrointestinal bleeding (UGIB) across different age groups and global regions.
- Analysis of the incidence and common etiologies of UGIB in various geographical areas, including North America, Europe, the Middle East, and Asia.
- Discussion of diagnostic approaches, emphasizing the role of endoscopy and the consideration of unusual pediatric causes.
Main Results:
- UGIB causes differ significantly between neonates, infants, children, and adolescents, with some overlap.
- Non-variceal causes (erosive esophagitis, gastritis, ulcers) are common in Western countries, while variceal bleeding is more prevalent in South Asia.
- Hematemesis is a strong indicator of UGIB; severe bleeding can stem from varices, peptic ulcers, or disseminated intravascular coagulation.
Conclusions:
- Familiarity with age-specific and regional UGIB causes is crucial for effective clinical orientation, diagnostic testing, and prompt therapy.
- The fundamental management of UGIB involves assessing severity, identifying causes, ensuring hemodynamic stability, and early endoscopic evaluation.
- Endoscopic interventions are vital for diagnosis and management, with surgery reserved for the most severe, refractory cases.
Abstract:
The etiology of upper gastrointestinal bleeding (UGIB) varies by age, from newborns to adolescents, with some of the causes overlapping between age groups. While particular causes such as vitamin K deficiency and cow's milk protein allergy are limited to specific age groups, occurring only in neonates and infants, others such as erosive esophagitis and gastritis may be identified at all ages. Furthermore, the incidence of UGIB is variable throughout the world and in different hospital settings. In North America and Europe, most UGIBs are non-variceal, associated with erosive esophagitis, gastritis, and gastric and duodenal ulcers. In recent years, the most common causes in some Middle Eastern and Far Eastern countries are becoming similar to those in Western countries. However, variceal bleeding still predominates in certain parts of the world, especially in South Asia. The most severe hemorrhage arises from variceal bleeding, peptic ulceration, and disseminated intravascular coagulation. Hematemesis is a credible indicator of a UGI source of bleeding in the majority of patients. Being familiar with the most likely UGIB causes in specific ages and geographic areas is especially important for adequate orientation in clinical settings, the use of proper diagnostic tests, and rapid initiation of the therapy. The fundamental approach to the management of UGIB includes an immediate assessment of severity, detecting possible causes, and providing hemodynamic stability, followed by early endoscopy. Unusual UGIB causes must always be considered when establishing a diagnosis in the pediatric population because some of them are unique to children. Endoscopic techniques are of significant diagnostic value, and combined with medicaments, may be used for the management of acute bleeding. Finally, surgical treatment is reserved for the most severe bleeding.
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