Upper gastrointestinal endoscopy in children with upper gastrointestinal bleeding

Abstract

Background: The purpose of this study was to evaluate the clinical presentations and features of upper gastrointestinal (UGI) endoscopy and the role of Helicobacter pylori in children with UGI bleeding.

Methods: A retrospective review was done of the medical records of 112 infants and children who presented with UGI bleeding. They underwent UGI endoscopy in the Taipei Veterans General Hospital, Taiwan between July 1996 and December 2000. Patients with hematemesis caused by swallowing caustic agents or foreign bodies were excluded.

Results: There were 112 patients involved in this study. Clinical manifestations included hematemesis (77 cases, 68.8%), tarry stool (37 cases, 33%) and hematochezia (9 cases, 8%). Fifty-three patients (47.3%) had underlying diseases, including neuromuscular deficits (17), hepatobiliary disease (17), renal insufficiency (8), Henoch-Schonlein purpura (HSP) (3), and cow milk allergy (3). Another 34 patients had a preceding acute febrile illness history. The endoscopic appearances included esophageal varices (10.7%), esophagitis or esophageal ulcers (30.4%), superficial gastric mucosal lesions (SGML) (44.6%), gastric ulcers (9.8%), duodenal ulcers (DU) (15.2%), and hemorrhagic erosive duodenitis (2.7%). Eleven cases (9.8%) showed negative findings. There were 13 (11.6%) patients receiving endoscopic hemostatic therapy. The rate of positive results in rapid urease tests in the patients without underlying diseases was 54.8%, which was significantly higher than that of the patients with underlying diseases (17.1%), while Helicobacter pylori was closely related to primary DU.

Conclusions: In children with UGI bleeding, UGI endoscopy provides an accurate diagnostic tool and also provides therapeutic intervention when needed. SGML was the most common endoscopic finding. About 30% of the infants and children with UGI bleeding had history of acute febrile illness. Half of the children had underlying diseases. Helicobacter pylori plays a role in a subgroup of children with UGI bleeding, particularly in children with primary DU.