HOME
Return to Table of Contents
PROSPECTIVE STUDY OF MAJOR UPPER GASTROINTESTINAL HAEMORRHAGE IN CHILDREN
S Hussey, K Kelleher, SC Ling
Division of Gastroenterology, Hepatology & Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
BACKGROUND: There are no large prospective cohort studies of major upper gastrointestinal hemorrhage (MUGIH) in children; the incidence and mortality rate are unknown.
AIM: To describe the etiology, management and outcome of a prospective cohort of children with MUGIH presenting in a tertiary care centre.
METHODS: Consecutive children diagnosed with MUGIH at the Hospital for Sick Children, Toronto between January 2005 and March 2007 were identified prospectively by gastroenterology staff and fellows and by review of hospital databases. MUGIH was defined as hematemesis or melena requiring administration of IV fluid bolus and/or blood products to restore circulating volume or maintain hemoglobin. Patients were excluded if bleeding was exclusively from the mouth, nose, ileum or colon. Medical charts were reviewed for data collection following discharge or death and again in October 2007 to collect 6 month follow-up data.
Results: 53 children had 65 episodes of MUGIH over the study period (mean age 7.3 yrs, range 1 day – 17 yrs; M:F 1:1.3). This represents a minimum incidence of 1 per 100 000 children per year in the Greater Toronto Area. The mean follow-up was 19.5 months. Although 9 children had no significant past history, 83% of patients had co-morbid illnesses including chronic liver disease (51%), portal hypertension (45%) and malignancy (16%). 23% had a previous liver transplant. 35% of MUGIH began outside the hospital setting. The mean nadir hemoglobin was 104g/L (range 42-166). All patients were placed on intravenous proton pump inhibitors. An upper endoscopy was performed following 75% of presentations. The median time from onset of bleed to endoscopy was 45 hrs. Therapeutic endoscopic intervention was performed at 22% of endoscopies. Recurrent MUGIH occurred in 17 patients (32%). Twelve children (23%) died during the study period, 1 due to a penetrating duodenal ulcer and the others due to the combined effects of their multiple comorbidities.
Conclusion: MUGIH is an uncommon presentation in children. Most patients had significant co-morbidities and at least half of the patients had a chronic liver disease. A minority of patients required therapeutic endoscopy. Further collaborative studies are now required to determine the best management for children with MUGIH.