Management of Gastrointestinal Bleeding in Children

Abstract

Gastrointestinal bleeding in infants and children is a potentially life-threatening problem that is encountered by virtually all practicing pediatric gastroenterologists. Youngsters with a normal hematocrit, hemodynamic stability, and a history consistent with an acute, self-limited illness most frequently need only close observation; others require more in-depth assessment and intervention. Meticulous attention to the patient's cardiopulmonary status and knowledge of appropriate pediatric resuscitation schemes form the cornerstones on which more specific therapeutic interventions are based. Many treatment techniques and approaches have been extrapolated for pediatric use from adult studies; the regimen implemented for a child should be individualized and based on factors such as patient size, underlying condition, and operator expertise. Although the physician treating pediatric gastrointestinal hemorrhage requires more than a modicum of patience and determination, this must be tempered with a ready willingness to seek consultation from surgical colleagues to ensure optimal outcomes. Knowledge of acid-suppressive and vasoactive medications is essential, as is familiarity with at least one injection technique and one thermocoagulation technique for hemostasis. Endoscopic sclerotherapy and variceal band ligation are equally efficacious in achieving control of acute variceal bleeding, but band ligation is emerging as the technique best suited for prophylaxis. Beta blockade appears to have a smaller and less well-defined role in pediatric variceal prophylaxis compared with that in adults, but random controlled trials are necessary to confirm this impression.