UPPER GASTROINTESTINAL BLEEDING IN CHILDREN

Abstract

Upper gastrointestinal bleeding in children may be life threatening. Frequent causes of upper gastrointestinal bleeding in children include variceal hemorrhage (most commonly extra-hepatic portal venous obstruction in Indian setting) and mucosal lesions (gastric erosion and ulcer secondary to drug intake). All patients should be evaluated for the source, degree and possible cause of the bleeding. A complete and thorough history and physical examination is therefore vital. Upper gastrointestinal endoscopy is the first line diagnostic procedure. The goals of therapy in a child with gastrointestinal bleeding should be directed towards hemodynamic resuscitation, cessation of bleeding from source and prevention of future episodes. Proton pump inhibitor and H2 receptor antagonists (both oral and parenteral) are the mainstay in the treatment of bleeding from mucosal lesion. Variceal bleeds are managed by infusion of vasoactive agents like octreotide and therapeutic emergency endoscopy after initial hemodynamic stabilization of the patient.