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Review
. 2024 Jan 23;50(1):13.
doi: 10.1186/s13052-024-01592-2.

Gastrointestinal bleeding in children: diagnostic approach

Marisa Piccirillo  1 , Valentina Pucinischi  1 , Maurizio Mennini  1 , Caterina Strisciuglio  2 , Elsa Iannicelli  3 , Maria Agostina Giallorenzi  3 , Silvia Furio  1 , Alessandro Ferretti  1 , Pasquale Parisi  1 , Giovanni Di Nardo  4
Affiliations
Review

Gastrointestinal bleeding in children: diagnostic approach

Marisa Piccirillo et al. Ital J Pediatr. .

Abstract

Different conditions may underlie gastrointestinal bleeding (GIB) in children. The estimated prevalence of GIB in children is 6.4%, with spontaneous resolution in approximately 80% of cases. Nonetheless, the initial approach plays a pivotal role in determining the prognosis. The priority is the stabilization of hemodynamic status, followed by a systematic diagnostic approach. GIB can originate from either upper or lower gastrointestinal tract, leading to a broad differential diagnosis in infants and children. This includes benign and self-limiting disorders, alongside serious conditions necessitating immediate treatment. We performed a nonsystematic review of the literature, in order to describe the variety of conditions responsible for GIB in pediatric patients and to outline diagnostic pathways according to patients' age, suspected site of bleeding and type of bleeding which can help pediatricians in clinical practice. Diagnostic modalities may include esophagogastroduodenoscopy and colonoscopy, abdominal ultrasonography or computed tomography and, when necessary, magnetic resonance imaging. In this review, we critically assess these procedures, emphasizing their respective advantages and limitations concerning specific clinical scenarios.

Keywords: Abdominal CT; Abdominal US; Endoscopy; Gastrointestinal bleeding; Hematemesis; Hematochezia; MR; Melena; Pediatric.

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Conflict of interest statement

The authors declare that they have no competing interest.

Figures

Fig. 1
Fig. 1
Proposed algorithm for the approach to children with hematemesis. Legend: aPPI: Proton Pump Inhibitors; bEGDS: Esophagogastroduodenoscopy; cPALS: Pediatric Advanced Life Support
Fig. 2
Fig. 2
Proposed algorithm for the approach to children with moderate-severe melena or hematochezia. Legend: aUS: Ultrasonography; bCT: Computed Tomography; cEGDS: Esophagogastroduodenoscopy; dOGIB: Obscure Gastrointestinal Bleeding
Fig. 3
Fig. 3
Proposed algorithm for the approach to children with obscure gastrointestinal bleeding. Legend: aMR: Magnetic Resonance; bCT: Computed Tomography; cVCE: Videocapsule endoscopy
See this image and copyright information in PMC

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