title: Approach to a child with upper gastrointestinal bleeding.
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.
authors.affiliation: Department of Pediatrics Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India. sunit.singhi@gmail.com
authors.forename: Sunit
authors.initials: S
authors.lastname: Singhi
authors.forename: Puneet
authors.initials: P
authors.lastname: Jain
authors.forename: M
authors.initials: M
authors.lastname: Jayashree
authors.forename: Sadhna
authors.initials: S
authors.lastname: Lal
mesh_terms: D021721:Balloon Occlusion; D002648:Child; D003906:Developing Countries; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D004630:Emergencies; D004945:Esophagoscopy / Q000379:methods; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D005773:Gastroscopy / Q000379:methods; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D007194:India; D033183:Interdisciplinary Communication; D010102:Oxygen Inhalation Therapy; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome; D041742:Upper Gastrointestinal Tract; D014812:Vitamin K / Q000627:therapeutic use; D014815:Vitamins / Q000627:therapeutic use
chemical_list: D005765:Gastrointestinal Agents; D054328:Proton Pump Inhibitors; D014815:Vitamins; D014812:Vitamin K