Trends in Upper Gastrointestinal Bleeding in Children: The Impact of Helicobacter pylori Infection and Non-Steroidal Anti-Inflammatory Drug Use

Abstract

Upper gastrointestinal bleeding (UGIB) is a significant concern in children, contributing to 6-20% of cases in pediatric intensive care units. This study evaluates the roles of Helicobacter pylori (H. pylori) infection and non-steroidal anti-inflammatory drug (NSAID) usage in the etiology of UGIB in children, with a particular focus on trends observed during the COVID-19 pandemic. We conducted a retrospective analysis of 103 pediatric patients who underwent esophagogastroduodenoscopy (EGD) for UGIB between January 2015 and December 2023. Of these, 88 patients were included in the final analysis, where the source of bleeding was successfully identified. Hematemesis was the most common presentation, and the source of bleeding was identified in 85.43% of cases. The prevalence of H. pylori infection remained stable across the pre-pandemic (39.7%) and post-pandemic (36.7%) periods. However, NSAID usage increased nearly threefold during the pandemic, with 36.7% of post-pandemic UGIB cases associated with NSAID use, compared to 12.1% pre-pandemic. These findings underscore the significant roles of H. pylori and NSAID use in pediatric UGIB, with a notable increase in NSAID-related cases during the pandemic.

Keywords: COVID-19 pandemic; Helicobacter pylori infection; children; esophagogastroduodenoscopy; hematemesis; hematochezia; melena; non-steroidal anti-inflammatory drugs; upper gastrointestinal bleeding.

Figure 1

Endoscopic image of the gastric mucosa from a 17-year-old male patient included in this cohort. This image shows a gastric ulcer located in the prepyloric region on the right and a rare finding of a pediatric gastric diverticulum on the left. The detailed visualization of the mucosal texture and vascular patterns aids in the diagnosis and management of these gastrointestinal abnormalities. Image taken from our personal collection.

Figure 2

Microscopic image showing Helicobacter pylori bacilli in a gastric biopsy from a pediatric patient included in this cohort, using Giemsa stain at 400x magnification. The bacilli appear as short, curved, or spiral-shaped organisms adhering to the gastric epithelial surface. Panel (A) shows a mild infiltration of inflammatory cells with presence of H. pylori bacilli on the surface of the epithelial cells. Panel (B) exhibits a more severe inflammatory response with denser infiltration of inflammatory cells, also showing H. pylori bacilli. Images taken from our personal collection.