The Indian Journal of Pediatrics

, Volume 80, Issue 4, pp 326–333 | Cite as

Approach to a Child with Upper Gastrointestinal Bleeding

  • Sunit Singhi
  • Puneet Jain
  • M. Jayashree
  • Sadhna Lal
Symposium on PGIMER Management Protocols in Gastrointestinal Emergencies

Abstract

Upper gastrointestinal bleeding (UGIB) is a potentially life threatening medical emergency requiring an appropriate diagnostic and therapeutic approach. Therefore, the primary focus in a child with UGIB is resuscitation and stabilization followed by a diagnostic evaluation. The differential diagnosis of UGIB in children is determined by age and severity of bleed. In infants and toddlers mucosal bleed (gastritis and stress ulcers) is a common cause. In children above 2 y variceal bleeding due to Extra-Hepatic Portal Venous Obstruction (EHPVO) is the commonest cause of significant UGIB in developing countries as against peptic ulcer in the developed countries. Upper gastrointestinal endoscopy is the most accurate and useful diagnostic tool to evaluate UGIB in children. Parenteral vitamin K (infants, 1–2 mg/dose; children, 5–10 mg) and parenteral Proton Pump Inhibitors (PPI’s), should be administered empirically in case of a major UGIB. Octreotide infusion is useful in control of significant UGIB due to variceal hemorrhage. A temporarily placed, Sengstaken-Blakemore tube can be life saving if pharmacologic/ endoscopic methods fail to control variceal bleeding. Therapy in patients having mucosal bleed is directed at neutralization and/or prevention of gastric acid release; High dose Proton Pump Inhibitors (PPIs, Pantoprazole) are more efficacious than H2 receptor antagonists for this purpose.

Keywords

Upper gastrointestinal bleeding Endoscopy Variceal bleed Octreotide 

Notes

Conflict of Interest

None.

Role of Funding Source

None.

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Copyright information

© Dr. K C Chaudhuri Foundation 2013

Authors and Affiliations

  • Sunit Singhi
    • 1
  • Puneet Jain
    • 1
  • M. Jayashree
    • 1
  • Sadhna Lal
    • 2
  1. 1.Department of Pediatrics Advanced Pediatrics CentrePost Graduate Institute of Medical Education and ResearchChandigarhIndia
  2. 2.Department of GastroenterologyPost Graduate Institute of Medical Education and ResearchChandigarhIndia

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