A Clinical Study Of390Children With Upper Gastrointestinal Bleeding

Objective To explore the clinical features and causes of children with upper gastrointestinal bleeding (UGIB).Methods Clinical data of390cases with UGIB hospitalized in Children’s Hospital of Chongqing Medical University between April2009and August2011were reviewed retrospectivelyResults1. There were257males and133females of the390UGIB cases.2. All ages of children could be suffered from UGIB,and most of cases were school-age children(49.5%) and infants and toddlers(29.5%) were followed.3. The duration when admitted was between1hour and2years, and58.7%was no more than1week4.The main clinical symptoms were hematemesis (46.9%), hematochezia (50.8%), and both of them (17.9%). The common concomitant symptoms were dyspepsia(72.3%), abdominal pain (60.3%), rashes of both lower limbs (15.4%),anemia (21.3%), syncope (3.1%), hemorrhagic shock (1.3%), etc. 5. Etiological classification revealed that local lesions in the upper gastrointestinal tract(UGIT,69.5%), systemic diseases (26.7%) and others (3.8%). The first5main diagnosed causes of UGIB were inflammation of UGIT(39.2%), ulcers (19.2%), Henoch-Schonlein purpura (HSP,17.4%), esophageal varices (3.6%), hiatus hernia(2.3%). In infants and toddlers stage, the common causes were inflammation of UGIT (41.7%,48/115), ulcers(18.3%,21/115), hiatus hernia (7.8%,9/115), upper digestive tract stenosis or obstruction (5.2%,6/115). For preschool and school-age children, the main causes were inflammation of UGIT(38.2%,105/275), HSP(24%,66/275), ulcers (19.6%,54/275), and esophageal varices (3.3%,9/275).6. Among three groups of infants and toddlers, preschool-age and school-age patients, the incidences of hematemesis, hematemesis complicated with hematochezia, abdominal pain and syncope showed statistical differences, respectively (P<0.01). There were no significant differences in the rates of dyspepsia, hematochezia, anemia and shock among all age groups (P>0.05)Among four groups of HSP, EV, inflammation and ulcers of UGIT, the incidence of shock showed no significant difference (P>0.05), while statistical significant differences were observed in the rates of other7symptoms, which were hematemesis, hematochezia, hematemesis complicated with hematochezia, abdominal pain, dyspepsia, anemia, syncope (All P<0.05)7. As the main diagnostic methods, electronic gastroscope alone diagnosed288out of the390cases(73.8%), and gastrointestinal barium meal examination diagnosed22out of the30cases (73.3%), while other90cases (90/390,23.1%)were defined by clinical and comprehensive diagnosis.Conclusions1. In children, all ages could be suffered from UGIB, especially infants and toddlers and school-age children.2. There were wide varieties of causes of UGIB, and the most primary cause was local lesion of upper gastrointestinal tract. The first5main diagnosed causes of UGIB were inflammation of upper gastrointestinal tract, ulcers, HSP, esophageal varices and hiatus hernia.3.The cause of UGIB was different as the age varied. In infants and toddlers stage, the most common causes were inflammation of UGIT, ulcers, hiatus hernia, upper digestive tract stenosis or obstruction. As for preschool and school-age children, inflammation of upper gastrointestinal tract, HSP, ulcers, and esophageal varices were the main causes.4.There was high morbidity of dyspepsia in all age groups. In infants and toddlers, the symptom of hematemesis was prominent. Abdominal pain was the main concomitant symptom in preschool-age patients. And it was abdominal pain and syncope that were the most common symptoms in school-age patients.In the patients with inflammation of UGIT, symptoms of dyspepsia and hematemesis were much more common than hematochezia. For ulcers, abdominal pain and dyspepsia were always atypical, while hematochezia, hematemesis associated with hematochezia were frequent symptoms, and syncope and anemia were also prominent. Abdominal pain and hematochezia were prominent in patients with HSP, and these two symptoms could occur before typical rashes. For patients with EV, the manifestations of bleeding were significant, which were hematemesis, hematochezia, hematemesis associated with hematochezia, and anemia.5. Though the clinical manifestations are complicated, some symptoms indicate etiology diagnosis.6. Gastroscopy is the first choice for the determination of the site and cause of UGIB, which combined with clinical manifestation and other auxiliary examinations can make the diagnosis earlier so as to avoid the delay of treatment.