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Primary and Secondary Prophylaxis of Gastrointestinal Bleeding in Children with Portal Hypertension: A Multicenter
Naire Sansotta1, Paola De Angelis2, Daniele Alberti3
1Paediatric Hepatology Gastroenterology and Transplantation, Hospital Papa Giovanni XXIII, 24127 Bergamo, Italy.
Insights
Pediatric portal hypertension (PH) management shows consensus in Italy, with endoscopy and non-selective beta-blockers (NSBBs) common for gastrointestinal varices. Further research is needed for evidence-based guidelines.
Area of Science:
- Pediatric Hepatology
- Gastroenterology
- Clinical Management
Background:
- Portal hypertension (PH) is a frequent complication in pediatric chronic liver diseases.
- Management of gastrointestinal (GI) varices and their bleeding in children with PH lacks standardized guidelines.
- This study evaluates current practices in managing GI varices in Italian pediatric centers.
Purpose of the Study:
- To assess the current medical, endoscopic, radiological, and surgical management of GI varices in children with PH in Italy.
- To identify areas of consensus and divergence in clinical practice.
- To inform the development of evidence-based guidelines.
Main Methods:
- A survey questionnaire was distributed to 21 major Italian pediatric hepatology centers.
- The questionnaire comprised 34 questions covering various aspects of GI variceal management.
- Data were collected from 16 responding centers, representing a 76% response rate.
Main Results:
- A total of 1206 children with PH were followed.
- Splenomegaly with hypersplenism was the primary indication for endoscopic surveillance.
- Primary prophylaxis involved endoscopy with non-selective beta-blockers (NSBBs) (50%) or endoscopy alone (38%).
- Acute variceal bleeding was managed with endoscopy, acid suppression, and octreotide.
- Secondary prophylaxis utilized endoscopy (100%) and NSBBs (87%).
- Transjugular intrahepatic portosystemic shunt (TIPS) was considered for treatment failure in 94% of centers.
Conclusions:
- Broad consensus exists among Italian centers regarding GI varices management in pediatric PH.
- Endoscopic screening is universally endorsed for children with clinical signs of PH.
- Further research is crucial to establish evidence-based guidelines and enhance care quality.
Abstract:
Background/Objectives: Portal hypertension (PH) is a common complication in children with chronic liver diseases. Primary and secondary prophylaxis of variceal bleeding in these patients remains controversial. Our study aims to evaluate the management of gastrointestinal (GI) varices in children with PH in Italy. Methods: A questionnaire was sent to 21 major pediatric hepatology centers. It included 34 questions referring to the medical, endoscopic, radiological, and surgical management of GI varices. Results: Out of 21 centers, 16 returned a completed questionnaire (survey response rate 76%) with a high level of completeness. A total of 1206 children with PH were under follow-up. Splenomegaly associated with hypersplenism was the main indication for endoscopic surveillance in all centers (100%). Primary prophylaxis was performed with endoscopy plus non-selective beta-blockers (NSBBs) in 50%, endoscopy alone in 38%, and NSBBs alone in 12%. All centers managed acute variceal bleeding with endoscopy within 24 h, acid suppression, and octreotide infusion. Secondary prophylaxis of variceal bleeding was conducted using endoscopy (100%) and NSBBs (87%). Transjugular intrahepatic portosystemic shunt (TIPS) was considered a good option when endoscopic treatment failed in 94% of centers. Conclusions: In Italy, there is broad consensus among centers regarding the management of gastrointestinal varices in children with portal hypertension. All participating centers endorsed the use of endoscopic screening for children presenting with clinical signs of portal hypertension. Nonetheless, further research is essential to establish evidence-based guidelines and to improve overall quality of care.
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