Define Upper Gastrointestinal Bleeding in Children. Describe its causes, investigations and management.

Definition

Upper gastrointestinal (GI) bleeding is bleeding from a source proximal to the ligament of Treitz, presenting as haematemesis (vomiting blood) and/or melena (black, tarry stools).

Causes BY Age

• Neonate — swallowed maternal blood, haemorrhagic disease of the newborn (vitamin K deficiency), stress ulcers.
• Infant/young child — oesophagitis, gastritis, Mallory-Weiss tear (forceful vomiting), reactive gastropathy.
• Older child — oesophageal varices (portal hypertension), peptic ulcer disease, drug-induced (NSAIDs).

Assessment & Investigations

• Confirm it is true blood and upper GI in origin; assess haemodynamic status (heart rate, BP, perfusion) and severity.
• CBC, coagulation profile, blood grouping/cross-match; liver function if varices suspected.
• Upper GI endoscopy — the key diagnostic and therapeutic tool.

Management

• Resuscitation first — IV access, fluids/blood to restore circulation, correct coagulopathy.
• Acid suppression — IV proton-pump inhibitor for ulcer/gastritis bleeds.
• Variceal bleed — octreotide + endoscopic band ligation/sclerotherapy (see portal hypertension).
• Treat the underlying cause.

Distinguishing Upper from Lower Gi Bleeding

• Upper — haematemesis and/or melena (black, tarry); source proximal to the ligament of Treitz.
• Lower — fresh red blood per rectum (haematochezia); different causes (fissure, polyp, intussusception, Meckel's).

Initial Stabilisation (stepwise)

• Assess airway, breathing, circulation; establish two large IV lines.
• Send CBC, coagulation and cross-match; restore circulation with fluids/blood.
• Start a proton-pump inhibitor; arrange urgent endoscopy once stable.
• Add octreotide + antibiotics if a variceal bleed is suspected.

Variceal bleeding from portal hypertension is common in Indian children.