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Upper gastrointestinal bleeding in children: an 11-year retrospective endoscopic investigation

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Abstract

Background

Upper gastrointestinal bleeding (UGIB) may present as hematemesis, coffee-ground emesis, or melena requiring esophagogastroduodenoscopy (EGD) for diagnosis and/or therapy. Worldwide, differences exist for the etiology of UGIB reflecting geographical differences in common disease states. In the past 25 years, there have been improvements in endoscopic optics. This study was undertaken to determine: 1) if identifying a bleeding source in UGIB have improved with better endoscopic optics, 2) geographic differences in causes of UGIB, 3) differences in severity of UGIB based on clinical factors, and 4) the likelihood of fi nding a bleeding source based on symptom duration and time to endoscopy.

Methods

A retrospective chart review was made on children having EGD for evaluation of UGIB. Data collected included type, etiology, and degree of bleeding.

Results

Of 2569 diagnostic procedures, 167 (6.5%) were performed for UGIB. The most common presentation was hematemesis (73.4%). Melena was associated with lower hemoglobin levels and higher transfusion rates. A source of UGIB was found in 57.0%, no cause in 11.4% and a questionable cause in 29.7%. A source was found less commonly in children with a history of UGIB less than one month and in those undergoing endoscopy over 48 hours after a bleeding episode.

Conclusions

Improved endoscopic optics has not changed diagnostic ability for UGIB. Etiologic differences for UGIB in children from varying geographic areas are related to indication for endoscopy, patient selection, and co-morbid conditions. Duration of bleeding and time to endoscopy after a bleeding episode may help predict when endoscopy should be performed to determine a bleeding source.

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Authors and Affiliations

  1. Division of Pediatric Gastroenterology, University of Mississippi Medical Center, Jackson, MS, 39216, USA

    Katherine Cleveland, Phyllis Bishop & Michael Nowicki

  2. Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS, 39216, USA

    Naveed Ahmad

  3. Division of Pediatric Gastroenterology, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA

    Michael Nowicki

Authors
  1. Katherine Cleveland
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  2. Naveed Ahmad
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  3. Phyllis Bishop
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  4. Michael Nowicki
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Correspondence to Michael Nowicki.

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Cleveland, K., Ahmad, N., Bishop, P. et al. Upper gastrointestinal bleeding in children: an 11-year retrospective endoscopic investigation. World J Pediatr 8, 123–128 (2012). https://doi.org/10.1007/s12519-012-0350-8

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  • DOI: https://doi.org/10.1007/s12519-012-0350-8

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