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Trends in Upper Gastrointestinal Bleeding in Children: The Impact of Helicobacter pylori Infection and Non-Steroidal
Felicia Galos1,2, Mara Ioana Ionescu2,3, Mihai Daniel Luca Mirea2
1Department of Pediatrics, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania.
Insights
Pediatric upper gastrointestinal bleeding (UGIB) is linked to Helicobacter pylori and NSAIDs. NSAID use significantly increased during the COVID-19 pandemic, contributing to more UGIB cases in children.
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
- Epidemiology
Background:
- Upper gastrointestinal bleeding (UGIB) is a critical issue in pediatric intensive care units.
- Helicobacter pylori (H. pylori) infection and NSAID use are known etiological factors in pediatric UGIB.
Purpose of the Study:
- To investigate the roles of H. pylori infection and NSAID usage in pediatric UGIB.
- To analyze trends in pediatric UGIB etiology during the COVID-19 pandemic.
Main Methods:
- Retrospective analysis of 103 pediatric patients undergoing esophagogastroduodenoscopy (EGD) for UGIB from January 2015 to December 2023.
- Final analysis included 88 patients with identified bleeding sources.
- Comparison of H. pylori prevalence and NSAID usage between pre-pandemic and post-pandemic periods.
Main Results:
- Hematemesis was the most frequent presentation of UGIB.
- H. pylori infection prevalence remained stable: 39.7% pre-pandemic vs. 36.7% post-pandemic.
- NSAID-associated UGIB cases increased nearly threefold post-pandemic (36.7%) compared to pre-pandemic (12.1%).
Conclusions:
- H. pylori and NSAID use are significant contributors to pediatric UGIB.
- A notable rise in NSAID-related pediatric UGIB cases occurred during the COVID-19 pandemic.
Abstract:
Upper gastrointestinal bleeding (UGIB) is a significant concern in children, contributing to 6-20% of cases in pediatric intensive care units. This study evaluates the roles of Helicobacter pylori (H. pylori) infection and non-steroidal anti-inflammatory drug (NSAID) usage in the etiology of UGIB in children, with a particular focus on trends observed during the COVID-19 pandemic. We conducted a retrospective analysis of 103 pediatric patients who underwent esophagogastroduodenoscopy (EGD) for UGIB between January 2015 and December 2023. Of these, 88 patients were included in the final analysis, where the source of bleeding was successfully identified. Hematemesis was the most common presentation, and the source of bleeding was identified in 85.43% of cases. The prevalence of H. pylori infection remained stable across the pre-pandemic (39.7%) and post-pandemic (36.7%) periods. However, NSAID usage increased nearly threefold during the pandemic, with 36.7% of post-pandemic UGIB cases associated with NSAID use, compared to 12.1% pre-pandemic. These findings underscore the significant roles of H. pylori and NSAID use in pediatric UGIB, with a notable increase in NSAID-related cases during the pandemic.
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