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©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
Age-specific causes of upper gastrointestinal bleeding in children
Marija Kocic, Petar Rasic, Vuk Marusic, Dragan Prokic, Djordje Savic, Maja Milickovic, Ivana Kitic, Tanja Mijovic, Adrijan Sarajlija
Marija Kocic, Dragan Prokic, Ivana Kitic, Department of Gastroenterology, Hepatology and Nutrition, Mother and Child Health Care Institute of Serbia “Dr. Vukan Cupic”, Belgrade 11000, Serbia
Petar Rasic, Djordje Savic, Maja Milickovic, Tanja Mijovic, Department of Abdominal Surgery, Mother and Child Health Care Institute of Serbia “Dr. Vukan Cupic”, Belgrade 11000, Serbia
Vuk Marusic, Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade 11000, Serbia
Dragan Prokic, Djordje Savic, Maja Milickovic, Ivana Kitic, Adrijan Sarajlija, Faculty of Medicine, University of Belgrade, Belgrade 11000, Serbia
Adrijan Sarajlija, Pediatric Day Care Hospital Department, Mother and Child Health Care Institute of Serbia “Dr. Vukan Cupic”, Belgrade 11000, Serbia
Adrijan Sarajlija, Faculty of Medicine, University of Eastern Sarajevo, Foča 73300, Bosnia and Herzegovina
Author contributions: Kocic M, Rasic P, Marusic V, Prokic D, Savic D, and Sarajlija A significantly contributed to the conceptualization, design, and data consolidation of the study; Rasic P, Marusic V, and Sarajlija A critically revised the article; Kocic M, Rasic P, Marusic V, Milickovic M, Kitic I, and Mijovic T conducted the literature search, data collection, and manuscript drafting; and all authors approved the final manuscript and agree to be accountable for all aspects of the work.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Petar Rasic, MD, Surgeon, Department of Abdominal Surgery, Mother and Child Health Care Institute of Serbia “Dr. Vukan Cupic”, Radoja Dakica 6-8, Belgrade 11000, Serbia. perasrv@yahoo.com
Received: July 25, 2023
Peer-review started: July 25, 2023
First decision: October 23, 2023
Revised: November 5, 2023
Accepted: December 1, 2023
Article in press: December 1, 2023
Published online: December 21, 2023
The etiology of upper gastrointestinal bleeding (UGIB) varies by age, from newborns to adolescents, with some of the causes overlapping between age groups. While particular causes such as vitamin K deficiency and cow’s milk protein allergy are limited to specific age groups, occurring only in neonates and infants, others such as erosive esophagitis and gastritis may be identified at all ages. Furthermore, the incidence of UGIB is variable throughout the world and in different hospital settings. In North America and Europe, most UGIBs are non-variceal, associated with erosive esophagitis, gastritis, and gastric and duodenal ulcers. In recent years, the most common causes in some Middle Eastern and Far Eastern countries are becoming similar to those in Western countries. However, variceal bleeding still predominates in certain parts of the world, especially in South Asia. The most severe hemorrhage arises from variceal bleeding, peptic ulceration, and disseminated intravascular coagulation. Hematemesis is a credible indicator of a UGI source of bleeding in the majority of patients. Being familiar with the most likely UGIB causes in specific ages and geographic areas is especially important for adequate orientation in clinical settings, the use of proper diagnostic tests, and rapid initiation of the therapy. The fundamental approach to the management of UGIB includes an immediate assessment of severity, detecting possible causes, and providing hemodynamic stability, followed by early endoscopy. Unusual UGIB causes must always be considered when establishing a diagnosis in the pediatric population because some of them are unique to children. Endoscopic techniques are of significant diagnostic value, and combined with medicaments, may be used for the management of acute bleeding. Finally, surgical treatment is reserved for the most severe bleeding.
Core Tip: This review provides general and comprehensive epidemiological data, overviewing the most common causes of upper gastrointestinal bleeding (UGIB) in children, in different age groups. The relevant literature in English on pediatric UGIB was searched until 2022, with special reference to age-related causes, unusual and rare causes, and risk factors. The literature search was performed using Medline via PubMed database (www.pubmed.gov), Google Scholar (www.scholar.google.com) and Cochrane Database, using the following terms: “neonates and infants” and “upper gastrointestinal bleeding”; “children” and “upper gastrointestinal bleeding”; “children” and “upper gastrointestinal bleeding” and “unusual causes”; “infants and children” and “upper gastrointestinal hemorrhage” and “unusual causes”.
