[Usefulness of endoscopy in the differential diagnosis of hemorrhage of the upper digestive tract in children].
One hundred and sixty two patients with upper and intermediate gastrointestinal hemorrhage studied under a prospective protocol are reported. Upper endoscopy revealed lesions of the upper gastrointestinal tract in 137 patients (89%); a barium swallow performed to 92 of them failed to confirm the endoscopic diagnosis in 66 (71.7%). In 99m Tc scan suggested ectopic gastric mucosa in 9 cases; Meckel's diverticulum was confirmed by laparotomy in 7 and gastrointestinal duplication in two of them. Selective mesenteric arteriography demonstrated bleeding ileo-cecal varices in one patient. The main causes of gastrointestinal hemorrhage in the current series were duodenal ulcer (22.8%), esophageal varices (14.8%), stress ulcers (14.2%), reflux esophagitis (7.4%), aspirin-induced gastritis (6.8%), gastric ulcer (5.6%) and ectopic gastric mucosa (5.6%). These diagnosis were characteristically distributed according to pediatric age-groups. The source of bleeding could be detected in 90% of the patients studied. A clinical approach to differential diagnosis of patients with gastrointestinal bleeding is presented.
Larrosa-Haro
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Servicio de Gastroenterología, Hospital de Pediatría, Guadalajara, Jalisco, México.
Coello-Ramírez
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P
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D004381:Duodenal Ulcer / Q000150:complications; D004724:Endoscopy; D004932:Esophageal and Gastric Varices / Q000150:complications; D004941:Esophagitis / Q000150:complications; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D006801:Humans; D007223:Infant; D008297:Male; D010438:Peptic Ulcer Hemorrhage / Q000175:diagnosis / Q000209:etiology; D011446:Prospective Studies; D011859:Radiography; D013276:Stomach Ulcer / Q000150:complications
Utilidad de la endoscopia en el diagnóstico diferencial de la hemorragia del tubo digestivo alto en niños.