Dhakshayani, R V (2011) Clinical and Etiological Profile of Children with Upper Gastrointestinal Bleed and Endoscopic Correlation. Masters thesis, Madurai Medical College, Madurai.
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Abstract
INTRODUCTION: Upper gastrointestinal bleed in children is a fairly common symptom encountered in paediatric practice. UGI bleed is an alarming symptom to the patients and parents and a challenge to the physician. Gastrointestinal bleed in children accounts for 10-15% of referrals to paediatric gastroenterology services1. Most aetiologies are self limiting and benign, but it is crucial not to miss conditions that may lead to severe consequences, if undiagnosed. UGI bleed constitutes 54%2 of all children presenting with gastro intestinal bleeding. Some causes span the entire paediatric range, while some others are common in particular age groups. Over the years of advancements in endoscopy, radiology and newer therapeutic modalities, it has been possible to narrow down to the cause of bleed more accurately and treat it more effectively. Acute gastro intestinal bleed usually presents suddenly, often unheralded by any symptom; in a few, the bleed may be slow and continuous, manifesting as anaemia or hemodynamic instability. In quite a number of these patients, there is no identifiable cause despite extensive investigations, posing diagnostic challenge and therapeutic dilemma to the treating physician. OBJECTIVES OF THE STUDY: To analyse 1. Etiology 2. Clinical presentation 3. Clinical and endoscopic correlation of upper gastrointestinal bleed in children aged 3 months to 12 years. DISCUSSION: In this study, 155 children in the age group of 3 months to 12 years, who presented with the primary symptom of overt upper gastrointestinal bleed during the study period were included and evaluated. We had 65 cases of variceal bleed and in the remaining 90 cases, the causes were non variceal, which included mucosal lesions of GIT, A- V malformations, Mallory-Weiss tear, spurious hematemesis etc. The cause could not be ascertained in a few children despite detailed and appropriate investigations. No sex predilection was observed in this study. male:female -1.1:1. But the M:F ratio among children above 6 years of age showed male preponderance.(1.4:1) About 60 children had atleast one episode of UGI bleed before the study period. Among them, 53(88.3%) had varices as the cause of recurrent bleed. This is consistent with a study by Mittal SK,16 et al, who in his review of 70 cases of EHPVO, reported that these children have a minimum of 3 to 5 episodes of bleeding before presentation. Similar observation was made by Fonkulsrud76. Major bleeds were the mode of presentation in 53.54% of children, and minor bleeds in 46.46% of cases. About 65.06 % of cases of major bleeds were due to varices, consistent with observations made by Tanner, et al9, Boyle JT et al15, and Robert Squires et al14. Minor bleeds were mostly due to non-variceal causes (84.7%); most commonly encountered being the mucosal lesions of GIT. This is comparable to observations by Robert Squires, et al14 and Abraham Bogoch, et al21. The difference observed in the incidence of major and minor GI bleeds among variceal and non variceal groups was found to be statistically significant. Resuscitation was required in a total of 95 cases ,62 of them(65.2%) being variceal bleeders and 33 (34.8%) non variceal bleeders. Left hypochondrial mass (splenomegaly) was the presenting complaint in 40.6%of cases and out of them, 96.8 % (61/63) had varices as the source of bleeding, the incidence is consistent with that observed by Webb, LJ et al21. Anemia (Hb < 11 gm/dl) was observed in 63.2% of children which could be presumed to be due to the blood loss. Prominent abdominal veins were seen in 6 cases of which 2 cases were due to chronic liver disease with portal hypertension. Prominent abdominal veins were seen only in 6.3 % (4/63) cases of EHPVO and this concurs with studies by Tanner S76 and Webb and Sherlock21. SUMMARY AND CONCLUSION: 1. A total of 155 children aged 3 months - 12 years with upper gastro intestinal hemorrhage were taken up for the study. 2. This study showed a male female ratio of 1.1:1 among UGI bleeders. 3. Most of the major bleeds were due to variceal etiology (65.1%), while majority of the minor bleeds were due to non-variceal causes (84.7%). 4. Recurrent bleeds occurred most frequently with varices (92.8%). 5. Ulcerogenic drug ingestion was present in 47.7% of the total cases, of which 62.11% showed evidence of GI mucosal changes and in another 18.73%the drugs were a trigger factor for bleeds in already existing varices. 6. Splenomegaly in children with upper GI bleeds, was found to occur most commonly (in 96.8%) due to portal hypertension and was a reliable clue in clinical diagnosis. 7. The etiology of upper GI hemorrhage was predominantly varices in 41.93%, of cases. The other causes were others were gastritis in 27.7%, esophagitis in 14.8%, Mallory-Weiss tear in 1.9%, hiatus hernia in 2.5% and A.V.malformation and duodenal polyp each in 0.6%. Peptic ulcer disease was noticed only in 5.8%of total bleeds. 8. Spurious hematemesis was the cause in 1.3% of these children.9. Endoscopy plays a very important role in the diagnosis and therapy of gastrointestinal bleed of variceal and non variceal etiology. Hence, endoscopy is recommended in all cases of UGI bleed.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Clinical ; Etiological Profile ; Children ; Upper Gastrointestinal Bleed ; Endoscopic Correlation |
| Subjects: | MEDICAL > Paediatrics |
| Depositing User: | Ravindran C |
| Date Deposited: | 13 Apr 2018 10:40 |
| Last Modified: | 13 Apr 2018 10:40 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/6989 |
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