[Gastrointestinal bleeding]

Abstract

OBJECTIVE: To present an analysis of the occurrence of gastrointestinal bleeding in children and emphasize: i) diagnostic methods; ii) the organized use of different therapeutic approaches in upper gastrointestinal bleeding; iii) the review of concepts, classifications and techniques used in endoscopy, which are important to the practice of clinical pediatrics. METHODS: Literary review of chapters selected from textbooks, pertinent articles obtained through the Medline system and active search, as well as personal archives belonging to the authors. RESULTS: The differential diagnosis of gastrointestinal bleeding in children varies according to the age. The causes of upper gastrointestinal bleeding are subdivided into variceal and nonvariceal. Nonselective beta-blockers are recommended to prevent variceal bleeding. Vasoactive drugs, such as somatostatin, octreotide, and glypressin may be used, showing good results in both variceal and nonvariceal acute bleeding. Both sclerotherapy and variceal ligation can be used in children to achieve variceal eradication. Cyanoacrylate is effective and presents the lowest complication rate related to gastric variceal bleeding. The presence of hemorrhage stigmata, such as active bleeding and visible vessel in ulcers is indicative of a higher risk for recurrent bleeding, suggesting the need for endoscopic hemostasis. Proton pump inhibitors are more efficacious than H2-receptor antagonists to promote the peptic ulcer healing. CONCLUSION: The correct etiologic diagnosis of gastrointestinal bleeding in children is fundamentally important to adopt the adequate therapeutic approach, whose main advances concern the pharmacological and the endoscopic treatment.