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Gastrointestinal bleeding in children: diagnostic approach
Marisa Piccirillo1, Valentina Pucinischi1, Maurizio Mennini1
1NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Pediatric Unit, Sant'Andrea University Hospital, Via Di Grottarossa1035-1039, 00189, Rome, Italy.
Insights
Pediatric gastrointestinal bleeding (GIB) affects 6.4% of children, often resolving spontaneously. A systematic diagnostic approach, prioritizing hemodynamic stabilization, is crucial for effective management and prognosis in pediatric GIB cases.
Area of Science:
- Pediatric Gastroenterology
- Clinical Diagnostics
Background:
- Gastrointestinal bleeding (GIB) in children has a prevalence of 6.4%, with most cases resolving without intervention.
- The initial management strategy significantly impacts the prognosis of pediatric GIB.
Purpose of the Study:
- To review conditions causing GIB in pediatric patients.
- To outline age- and presentation-specific diagnostic pathways for GIB in children.
- To aid pediatricians in clinical decision-making for GIB.
Main Methods:
- Nonsystematic literature review.
- Analysis of diagnostic modalities including endoscopy, imaging (ultrasound, CT, MRI).
- Assessment of procedure advantages and limitations in pediatric GIB scenarios.
Main Results:
- GIB in children can stem from diverse upper or lower gastrointestinal tract conditions, ranging from benign to severe.
- Diagnostic approaches vary based on patient age, bleeding site, and bleeding type.
- Endoscopic and imaging techniques have specific roles, benefits, and drawbacks in diagnosing pediatric GIB.
Conclusions:
- Effective management of pediatric GIB requires prompt hemodynamic stabilization and a structured diagnostic workup.
- Understanding the differential diagnosis and appropriate use of diagnostic tools is essential for optimal outcomes.
- This review provides a framework for pediatricians to navigate the complexities of diagnosing GIB in children.
Abstract:
Different conditions may underlie gastrointestinal bleeding (GIB) in children. The estimated prevalence of GIB in children is 6.4%, with spontaneous resolution in approximately 80% of cases. Nonetheless, the initial approach plays a pivotal role in determining the prognosis. The priority is the stabilization of hemodynamic status, followed by a systematic diagnostic approach. GIB can originate from either upper or lower gastrointestinal tract, leading to a broad differential diagnosis in infants and children. This includes benign and self-limiting disorders, alongside serious conditions necessitating immediate treatment. We performed a nonsystematic review of the literature, in order to describe the variety of conditions responsible for GIB in pediatric patients and to outline diagnostic pathways according to patients' age, suspected site of bleeding and type of bleeding which can help pediatricians in clinical practice. Diagnostic modalities may include esophagogastroduodenoscopy and colonoscopy, abdominal ultrasonography or computed tomography and, when necessary, magnetic resonance imaging. In this review, we critically assess these procedures, emphasizing their respective advantages and limitations concerning specific clinical scenarios.
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