Publication:

Clinico-etiological pattern of upper gastrointestinal bleeding in children

Background Upper GI bleeding (UGIB) is defined as bleeding occurring proximal to ligament of treitz. Upper gastrointestinal bleeding (UGIB) can lead to potentially serious and life-threatening clinical situation in children. Globally, the cause of UGIB differs significantly depending on variations in patient population and the presence of comorbid conditions. The objective of this study was to understand the clinico-etiological pattern of upper gastrointestinal bleeding in children in the age group 5-18 years, at a tertiary care centre in central India.

Methods This prospective study was carried out at a tertiary health care centre between January 2011 and August 2012. We consecutively enrolled all patients in the age group 5-18 years who came to our centre with hematemesis or hematemesis and malena both. Blood sample for CBC, stool sample for occult blood was taken and Ultrasonography of abdomen for liver echotexture, portal vein diameter/pressure and splenomegaly, done. Then, all patients underwent upper gastro intestinal endoscopy (Olympus GIF-V70 upper GI video endoscope).

Results Total 112 patients were included in the study during the study period. UGIB is most common in the age group 5-10 years (71.4%), followed by 10-14 years (26.8%). Hematemesis is the most common presenting symptom (75%) followed by both hematemesis and melena (25%). The most common causes of UGIB on EGD were oesophageal or gastric varices (91.1%) followed by erosive gastritis (5.3%), gastric ulcer (1.8%) and esophagitis (1.8%). Most common finding on ultrasonography (USG) abdomen was extra-hepatic portal venous obstruction (EHPVO) 75%, followed by liver cirrhosis (16.1%). No abnormality was detected on USG in 8.9% of patients.

Conclusions We conclude that Upper GI bleeding is more common in 5-10 years age group with hematemesis as the main presenting symptom. The causes of upper GI bleeding in children in developing countries are different from those in developed countries (variceal bleeding due to extra hepatic portal venous obstruction is the most common cause and peptic ulcer is rare).