Age-specific causes of upper gastrointestinal bleeding in children

Table 1 Common causes of upper gastrointestinal bleeding in neonates[1,3,5,24]

Cause	Bleeding source location
Swallowed blood	Non-GI bleeding
Nasogastric tube placement	Stomach
Stress-related gastritis	Stomach
CMPA	Stomach, duodenum
NEC	Lower GI tract
Vitamin K deficiency	Distinct locations
DIC	Distinct locations
Congenital coagulation disorders1	Distinct locations

¹Hemophilia, Von Willebrand disease, etc.

CMPA: Cow’s milk protein allergy; DIC: Disseminated intravascular coagulation; GI: Gastrointestinal; NEC: Necrotizing enterocolitis.

Table 2 Common causes of upper gastrointestinal bleeding in infants[1,3,5,17,26]

Cause	Bleeding source location
Erosive esophagitis	Esophagus
Reflux esophagitis	Esophagus
Ingestion of caustic substances and foreign bodies	Esophagus, stomach
Erosive gastritis	Stomach
Stress ulcers	Stomach
Drug-induced gastritis (most commonly by NSAIDs)	Stomach
PGS	Stomach
CMPA	Stomach, duodenum

CMPA: Cow’s milk protein allergy; NSAIDs: Non-steroidal anti-inflammatory drugs; PGS: Prolapse gastropathy syndrome.

Table 3 Common causes of upper gastrointestinal bleeding in toddlers[1,4,18]

Cause	Bleeding source location
Erosive esophagitis	Esophagus
Mallory-Weiss tear	Esophagus
Ingestion of caustic substances and foreign bodies	Esophagus, stomach
Variceal bleeding associated with portal hypertension	Esophagus, stomach
Erosive gastritis	Stomach
Peptic ulcers	Stomach
PGS	Stomach
Drug-induced gastritis (most commonly by NSAIDs)	Stomach

NSAIDs: Non-steroidal anti-inflammatory drugs; PGS: Prolapse gastropathy syndrome.

Table 4 Common causes of upper gastrointestinal bleeding in children ages > 3 yr[1,4,5,24,50]

Cause	Bleeding source location
Erosive esophagitis	Esophagus
Reflux esophagitis	Esophagus
Mallory-Weiss tear	Esophagus
Variceal bleeding associated with portal hypertension	Esophagus, stomach
Erosive gastritis	Stomach
Stress ulcers	Stomach
Drug-induced gastritis (most commonly by NSAIDs)	Stomach
Helicobacter pylori gastritis	Stomach
Peptic ulcers	Stomach, duodenum
Acquired hematological disorders (ITP, leukemia, etc.)	Distinct locations

ITP: Idiopathic thrombocytopenic purpura; NSAIDs: Non-steroidal anti-inflammatory drugs.

Table 5 Unusual causes of upper gastrointestinal bleeding in children, based on age

Cause	Age of onset	Bleeding source location
Esophageal duplications[60,62]	All ages	Esophagus
Eosinophilic esophagitis[63]	Children ≥ 3 yr	Esophagus
Gastric duplications[65]	All ages	Stomach
Eosinophilic gastritis	Children ≥ 3 yr	Stomach
Gastric GIST[69]	Children ≥ 3 yr	Stomach
Lymphoma[70]	Children ≥ 3 yr	Stomach
Schwannomas[71,72]	Toddlers, children ≥ 3 yr	Stomach
Focal foveolar hyperplasia[73]	Infants	Stomach
Bezoar[77]	Children ≥ 3 yr	Stomach
Duplications of duodenum[56,60]	All ages	Duodenum
Duodenal varices[78]	Children ≥ 3 yr	Duodenum
Blunt duodenal trauma[81]	Children ≥ 3 yr	Duodenum
Food as a foreign body	Children ≥ 3 yr	Duodenum
Hemobilia[83,84]	All ages	Biliary tract
Dieulafoy’s lesions[89-92]	All ages	Distinct locations
Peptic ulcers in ZES[94]	Children ≥ 3 yr	Distinct locations
Peutz-Jeghers syndrome[98]	Children ≥ 3 yr	Distinct locations
Crohn’s disease[99]	Children ≥ 3 yr	Distinct locations
HSP[101,104,105]	Toddlers, children ≥ 3 yr	Distinct locations

GIST: Gastrointestinal stromal tumor; HSP: Henoch-Schönlein purpura; ZES: Zollinger-Ellison syndrome.