How is upper gastrointestinal (GI) bleeding in children older than 2 years treated?

Updated: Dec 19, 2018
  • Author: Wayne Wolfram, MD, MPH; Chief Editor: Robert K Minkes, MD, PhD  more...
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Esophageal varices result from portal hypertension, regardless of the age group. Once the diagnosis of gastric or esophageal varices has been confirmed, treatment is initiated. Most bleeding episodes stop spontaneously and respond to blood products and careful monitoring.

Pharmacologic therapy, administered as necessary, is directed at reducing portal venous blood flow. Vasopressin, octreotide, and beta blockers have been used systemically to control bleeding varices.

Balloon tamponade with a Sengstaken-Blakemore or Minnesota tube has yielded up to an 80% success rate in controlling bleeding varices, but rebleeding and serious complications, such as pressure necrosis or misplacement, make this technique less useful.

Endoscopic sclerotherapy with injection of sodium morrhuate controls bleeding with a success rate of 90%-95%. Generally, endoscopic sclerotherapy is repeated at 2- to 4-week intervals after the acute bleed to prevent recurrence.

Variceal banding offers results at least comparable to sclerotherapy but is more difficult to perform in children because of the smaller size of the esophagus.

In the approximately 20% of cases in which conservative management fails (defined by multiple transfusion requirements or an inability to maintain hemodynamic stability) with combined pharmacotherapy and endoscopic treatments, shunt and non-shunt surgeries are the definitive treatment.

For intrahepatic portal hypertension, TIPS provides temporary decompression of the intrahepatic portal vein into the hepatic veins. Surgical portosystemic or portoportal shunts are reserved for refractory cases and/or when liver transplantation is not an option.

Nonshunt operations include esophageal transaction and devascularization of the gastroesophageal varices (Sugiura procedure), but neither is commonly performed.

A study reviewed the diagnosis and management of upper gastrointestinal bleeding in children. The study determined that after the diagnosis is established, the physician should start a proton pump inhibitor or histamine 2 receptor antagonist in children with upper gastrointestinal bleeding. The study added that consideration should also be given to the initiation of vasoactive drugs in all children in whom variceal bleeding is suspected. [10]

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