What is the role of medications in the treatment of pediatric gastrointestinal (GI) bleeding?

Updated: Dec 19, 2018
  • Author: Wayne Wolfram, MD, MPH; Chief Editor: Robert K Minkes, MD, PhD  more...
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Answer

Histamine-2 blockers or proton-pump inhibitors (PPI) are used to inhibit gastric acid production in peptic ulcer disease, gastroesophageal reflux disease (GERD), and duodenal ulcer disease. Alkaline suspensions are used to directly neutralize gastric acid secretions. Bleeding from esophageal varices may be prevented with vasoconstrictors, such as octreotide. Those with the etiology of infectious diarrhea should not be given antimotility agents, though some may benefit from antibiotics.

Somatostatin is not currently available in the United States for pediatric use. It is a hormone produced by the body that inhibits adenylate cyclase and therefore the production of cyclic AMP. Although it decreases pituitary secretion of growth hormone and thyrotropin, it also has physiologic effects of inhibiting secretion of serotonin, gastrin, vasoactive intestinal peptide (VIP), and many other hormones (eg, insulin, glucagon). It decreases intestinal motility and gastric emptying, but it is not recommended for use. Octreotide, a somatostatin analog, has been more widely adopted for the indication of variceal bleeding as secondary prophylaxis and, in some, primary prophylaxis.


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