Approach To Patient

Acute Upper Gastrointestinal Bleeding in Children - Approach to the Patient

Editors: Dawn Ebach MD; Allen Shaughnessy PharmD, M Med Ed, FCCP; Scott A. Barron MD, FAAP

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Background Information

Description

  • potentially life-threatening bleeding from the gastrointestinal tract above the ligament of Treitz, often presenting with bright red or coffee ground-like emesis
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Also Called

  • acute UGIB
  • acute upper gastrointestinal hemorrhage

Classifications

  • classification of upper gastrointestinal bleeding by etiology
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    • nonvariceal bleeding
      • reported to be most common type in children
      • common causes include
        • Mallory-Weiss tears
        • erosive esophagitis
        • peptic ulcers
        • emetogenic gastropathy (prolapse gastropathy) (J Pediatr Gastroenterol Nutr 2000 Apr;30(4):458)
      • less common causes
        • Dieulafoy lesions
        • arteriovenous malformations
        • telangiectasias
    • variceal bleeding
      • commonly associated with cirrhosis and chronic liver disease leading to portal hypertension and eventual esophageal varices
      • may also be associated with noncirrhotic liver fibrosis or portal venous malformation/cavernous transformation (Expert Rev Gastroenterol Hepatol 2015 May;9(5):575)

Incidence and Prevalence

  • reported to account for ≤ 20% of all gastrointestinal bleeds in children
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    • STUDY SUMMARY
      annual incidence of upper gastrointestinal bleeding in children 22.2 cases per 10,000 hospital discharges in the United States
      COHORT STUDY: Curr Med Res Opin 2014 Jun;30(6):1065

    • STUDY SUMMARY
      20% prevalence of upper gastrointestinal bleeding among children visiting emergency departments in the United States
      COHORT STUDY: Curr Med Res Opin 2015 Feb;31(2):347

  • incidence in France reported to be 1-2 cases per 10,000 children
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  • incidence of variceal bleeding due to portal hypertension reported to be 1 per 200,000 children in Canada
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  • STUDY SUMMARY
    annual incidence of peptic ulcer bleeding 0.5-4.4 cases per 100,000 children in United States
    COHORT STUDY: J Pediatr Gastroenterol Nutr 2012 Jun;54(6):733

Risk Factors

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1Level 1 (likely reliable) Evidence
Representing research results addressing clinical outcomes and meeting an extensive set of quality criteria which minimizes bias.
There are two types of conclusions which can earn a Level 1 label: levels of evidence for conclusions derived from individual studies and levels of evidence for conclusions regarding a body of evidence.
2Level 2 (mid-level) Evidence
Representing research results addressing clinical outcomes, and using some method of scientific investigation, but not meeting the quality criteria to achieve Level 1 evidence labeling.
3Level 3 (lacking direct) Evidence
Representing reports that are not based on scientific analysis of clinical outcomes. Examples include case series, case reports, expert opinion, and conclusions extrapolated indirectly from scientific studies.

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