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Upper gastrointestinal bleeding in Bangladeshi children: Analysis of 100 cases
Md Wahiduzzaman Mazumder1, Md Benzamin2
1Department of Pediatric Gastroenterology and Nutrition, Bangabandhu Sheikh Mujib Medical University, Dhaka 1000, Bangladesh. mazumdermw@gmail.com.
Insights
Ruptured esophageal varices are the leading cause of upper gastrointestinal bleeding in children in Bangladesh. Endoscopic findings reveal this as the primary diagnosis in pediatric patients presenting with hematemesis or melena.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Clinical Endoscopy
Background:
- Upper gastrointestinal bleeding (UGIB) in children presents a significant clinical challenge.
- Etiology of UGIB varies globally based on demographics and comorbidities.
Purpose of the Study:
- To document endoscopic findings of upper gastrointestinal bleeding in pediatric patients.
- To identify the primary causes of UGIB in children at a tertiary care center in Bangladesh.
Main Methods:
- Retrospective analysis of 100 pediatric patients (≤16 years) with UGIB symptoms.
- Upper gastrointestinal endoscopy performed after initial stabilization.
- Diagnostic investigations for portal hypertension and liver disease were conducted.
Main Results:
- Ruptured esophageal varices accounted for 65% of UGIB cases.
- Hematemesis was the predominant symptom (75%).
- Gastric erosions (5%) and prolapsed gastropathy (2%) were less common causes.
Conclusions:
- Ruptured esophageal varices are the most frequent cause of pediatric UGIB in Bangladesh.
- Endoscopic evaluation is crucial for diagnosing UGIB causes in children.
- Gastric erosions and prolapsed gastropathy are other identified causes.
Background:
Upper gastrointestinal bleeding (UGIB) is defined as bleeding that occurs proximal to the ligament of Treitz and can sometimes lead to potentially serious and life-threatening clinical situations in children. Globally, the cause of UGIB differs significantly depending on the geographic location, patient population and presence of comorbid conditions.
Aim:
To observe endoscopic findings of UGIB in children at a tertiary care center of Bangladesh.
Methods:
This retrospective study was carried out in the department of Pediatric Gastroenterology and Nutrition of Bangabandhu Shiekh Mujib Medical University, a tertiary care hospital of Bangladesh, between January 2017 and January 2019. Data collected from hospital records of 100 children who were 16 years of age or younger, came with hematemesis, melena or both hematemesis and melena. All patients underwent upper gastrointestinal endoscopy (Olympus CV 1000 upper gastrointestinal video endoscope) after initial stabilization. Necessary investigations to diagnose portal hypertension and chronic liver disease with underlying causes for management purposes were also done.
Results:
A total of 100 patients were studied. UGIB was common in the age group 5-10 years (42%), followed by above 10 years (37%). Hematemesis was the most common presenting symptom (75%) followed by both hematemesis and melena (25%). UGIB from ruptured esophageal varices was the most common cause (65%) on UGI endoscopy followed by gastric erosion (5%) and prolapsed gastropathy (2%). We observed that 23% of children were normal after endoscopic examination.
Conclusion:
Ruptured esophageal varices were the most common cause of UGIB in children in Bangladesh. Other causes included gastric erosions and prolapsed gastropathy syndrome.
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