pediatric gastrointestinal gi bleeding

WHAT IS PEDIATRIC GASTROINTESTINAL (GI) BLEEDING?

Gastrointestinal (GI) Bleeding is a common condition in children and can occur in any area from the gastrointestinal tract, from the mouth to the anus.

Pediatric Gastrointestinal (GI) Bleeding includes any sort of bleeding that happens in a child’s gastrointestinal (GI) tract. GI bleeding is, in fact, the result of several underlying causes.

Bleeding in the upper GI tract could be an indication of issues in the esophagus, duodenum, or stomach, such as ulcers or persistent irritation.

Bleeding in the lower GI tract could be an indication of issues in the large intestine (colon), including the rectum, because of polyps, fissures, infections, or hemorrhoids.

Moreover, other inflammatory conditions like Crohn’s Disease and Colitis can also lead to bleeding in the lower GI tract.

WHY DOES GI BLEEDING HAPPEN?

In cases of upper GI bleeding, the stomach acid can irritate the lining of the esophagus to an extent that it results in bleeding. In some other cases, retching and vomiting can cause a tear in the lining of the lower esophagus, or abnormal veins (varices) can be present if there exists a liver condition.

Certain medications, such as aspirin, or certain infections (particularly from the bacteria H.pylori) can lead to ulcers in the stomach and duodenum that can cause GI bleeding. Other uncommon sources are polyps (polyps are finger-like overgrowths of the lining of the intestine and bleed when the stool rubs against them) and abnormal blood vessels.

In cases of lower GI Bleeding, straining and the passage of hard or wide stool can result in injury in the lining of the rectum causing bleeding.

The most common causes of GI bleeding in children include the following:

• Anal fissures – a small tear in the thin, moist tissue that lines the anus. An anal fissure can occur when the child passes hard or large stools during a bowel movement. Anal fissures typically cause pain and may result in bleeding with bowel movements. Anal fissures are common and can affect people at any age.
• Esophagitis – a condition that results in the inflammation of the esophagus.
• Immature digestive system (in infants)
• Inflammatory Bowel Disease (IBD)
• Milk protein allergy
• Peptic Ulcer disease – a soar in the lining of the stomach or the upper part of the intestine called the duodenum. The ulcer develops when the stomach acid damages the walls of the stomach or the duodenum.
• Polyps in the colon
• Vascular lesions
• Vitamin K deficiency at birth.

WHAT ARE THE SYMPTOMS OF GASTROINTESTINAL (GI) BLEEDING?

The symptoms of GI bleeding can either be obvious (overt) or hidden (occult) and depend on the location of the bleeding.

Overt bleeding symptoms, i.e. the most obvious symptoms of GI bleeding are:

• Blood vomits that might be red or dark brown and look like coffee grounds
• Black, tarry stool
• Rectal bleeding, either in or with stool.

The occult symptoms could be:

• Lightheadedness
• Difficulty in breathing
• Extreme tiredness
• Losing consciousness
• Pain in the chest
• Pain in the abdomen

WHAT MOTHERS NEED TO KNOW PEDIATRIC GASTROINTESTINAL (GI) BLEEDING?

Gastrointestinal (GI) Bleeding in infants and children is an alarming symptom to parents. While minor GI bleeding is usually a self-limiting condition that requires minimal intervention, it can certainly be a life-threatening condition in some cases.

With the advent of symptoms, you should consult a pediatric gastroenterologist for an immediate assessment with the objective of getting answers to the following questions:

• Is the child safe?
• Is it significant bleeding?
• Is the child actively bleeding now?
• Is there a known condition that makes the child susceptible to bleeding?

The source of bleeding, extent or magnitude of the bleeding, duration of the bleeding, and associated symptoms should be discussed with the doctor.

HOW IS GASTROINTESTINAL (GI) BLEEDING IN CHILDREN DIAGNOSED?

A pediatric gastroenterologist would first need to know the underlying cause of the child’s gastrointestinal bleeding and for that an endoscopy and/ or a colonoscopy would need to be done. Both these procedures are minimally invasive – a slender tube with an attached camera is inserted into the gastrointestinal tract. The pediatric gastroenterologist uses the real-time images from the camera to identify ulcers, obstructions and other possible issues.

(During endoscopy, the slender tube with the camera enters the GI tract through the mouth and down into the esophagus, and in colonoscopy, the slender tube goes into the rectum and up into the colon.

HOW IS GASTROINTESTINAL (GI) BLEEDING IN CHILDREN TREATED?

The treatment of GI bleeding largely depends on the underlying cause of the bleeding.

The treatment of upper GI bleeding usually involves medications to help reduce the irritation caused by the stomach acid. Apart from medications, the child’s pediatric gastroenterologist would ask for some changes in the child’s diet so as to minimize the acid production.

For the treatment of lower GI bleeding, the pediatric gastroenterologist would recommend a colonoscopy to remove polyps or perform a minimally invasive procedure to cut off the blood supply to the hemorrhoids.

Further, medications may be necessary for the treatment of infections or to control persistent inflammation from Crohn’s disease or colitis.