Description

Upper gastrointestinal bleeding (UGIB) is classified based on its origin of bleeding being proximal to the ligament of Treitz. The classic clinical symptom is hematemesis which is emesis of bright red blood or coffee grounds. Other symptoms include melena, occult blood loss, and in the case of severe UGIB, hematochezia.

Epidemiology

• The incidence of GI bleeding in children is not well established in the general population.
• Large, prospective studies have assessed the prevalence of upper GI bleeding in pediatric critical care settings to range from 6.4% to 25% of admissions.
• 80% of UGIB stop bleeding spontaneously.

Etiology

• Neonatal period (birth to 1 month)
  • Swallowed maternal blood
  • Necrotizing enterocolitis
  • Duodenal web, antral web
  • Hemorrhagic disease of the newborn
  • Esophagitis
  • Gastritis
  • Stress ulcer
  • Foreign body irritation
  • Vascular malformation
  • GI malformation
• Infancy (1 month to 2 years)
  • Esophagitis/gastritis
  • Stress ulcer
  • Mallory-Weiss tear
  • Pyloric stenosis
  • Vascular malformation
  • Duplication cysts
  • Metabolic disease
• Preschool age (2 to 5 years)
  • Esophageal varices
  • Esophagitis/gastritis/ulcer
  • Foreign body/bezoar
  • Mallory-Weiss tear
  • Vascular malformation
  • Meckel diverticulum
• School age (>5 years)
  • Esophageal varices
  • Infection
  • Esophagitis/gastritis/ulcer
  • Mallory-Weiss tear
  • Inflammatory bowel disease
  • Drugs: NSAIDS, α-adrenergic antagonists
  • Helicobacter pylori
• All ages: liver failure—coagulopathy

General Prevention

• Avoid or minimize the use of drugs that can lead to peptic ulcers, for example, NSAIDs and aspirin.
• Correct coagulopathy.
• In patients with chronic GI conditions, optimize therapy and monitoring.
• Use prophylactic medical or endoscopic therapy in patients with a history of variceal bleeding.