7.2 Gastrointestinal bleeding
1 The causes of gastrointestinal (GI) bleeding in infants and children fall into age-specific diagnostic categories
2 The majority of GI bleeding ceases spontaneously, requiring no treatment or treatment on the basis of a presumptive diagnosis.
Introduction
The epidemiology of GI bleeding in children is very limited. The reported incidence of GI bleeding of 6.4% in paediatric ICU patients1 and the most frequent diagnoses confirmed endoscopically2 (duodenal and gastric ulcers, oesophagitis, gastritis, and varices) represent selected populations and are not representative of the ambulatory paediatric population.
Aetiology
The aetiology of GI bleeding is best considered within defined age groups, with some overlap between groups, and the likely location of the bleed, as guided by history and examination (see Tables 7.2.1 and 7.2.2).
Neonates | Infants | Toddlers and school age |
---|---|---|
Ingested maternal blood | Anal fissure | Anal fissure |
Necrotising enterocolitis | Protein sensitive enterocolitis | Juvenile colonic polyps |
Protein-sensitive enterocolitis | Hirschsprung’s enterocolitis | Infectious gastroenteritis |
Hirschsprung’s enterocolitis | Ischaemic enterocolitis | Meckel’s diverticulum |
Ischaemic enterocolitis | Infectious gastroenteritis | Intussusception |
Infectious gastroenteritis | Meckel’s diverticulum | Ischaemic enterocolitis |
Congenital bleeding disorders | Intussusception | Haemolytic uraemic syndrome |
Haemolytic–uraemic syndrome | Henoch–Schönlein purpura | |
Bleeding disorders | Inflammatory bowel disease | |
Vascular malformation | Vascular malformation | |
Inflammatory bowel disease | Bleeding disorders |
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