Upper gastrointestinal bleeding in children: An 11-year retrospective analysis of clinico-endoscopic profile and management

Upper gastrointestinal bleeding

Section: Research Paper
Issue
Vol. 48 No. 1 (2026): Volume 48 Issue 1
Pages
53-58

Keywords:

argon plasma coagulation, endoscopy, variceal band ligation, vascular ectasia.

Abstract

Background: Upper gastrointestinal (GI) bleeding is defined as bleeding occurring proximal to the ligament of Treitz and specifies a significant health problem in children.


Aims: The study planned to assess the clinical presentation, underlying causes, and the role of endoscopy in the diagnosis and management of upper GI bleeding in children.


Methods: A retrospective study was implemented from November 2014 to May 2025 at a tertiary referral center in Sulaymaniyah, Iraq. The study included all hospitalized children and adolescents under 18 years of age with upper GI bleeding who underwent esophagogastroduodenoscopy (EGD). Data on demographic characteristics, clinical history, endoscopic findings, and therapeutic interventions were collected from the patients’ medical records.


Results: Out of 941 EGDs performed over eleven years, 184 were for GI bleeding. The mean patient age was 5.5 years, with 52.7% of the participants being male. Presentations encompassed hematemesis in 55.4%, melena in 28.9%, both in 15.2%, and isolated hematochezia in 0.5%. The most common endoscopic findings were gastritis (39.1%), reflux esophagitis (11.9%), duodenal ulcers (11.4%), and gastric ulcers (10.8%). No abnormalities were observed in 16.3% of cases. Therapeutic interventions included variceal band ligation (1.6%), endoscopic clipping (0.5%), balloon dilatation for esophageal stricture and pyloric stenosis (each 0.5%), and argon plasma coagulation (APC) for hereditary hemorrhagic telangiectasia (0.5%).


Conclusions: The study spotlights the value of clinico-endoscopic correlation in upper GI bleeding in the pediatric age group and establishes a cornerstone for future prospective studies and follow-up strategies.

References

  1. Mackenzie PD, Rogers M, Gallagher M, Rockall T. Management of massive gastrointestinal haemorrhage. Surgery (Oxford). 2019;37(10):565–575. Doi: https://doi.org/10.1016/j.mpsur.2019.07.013
  2. Piccirillo M, Pucinischi V, Mennini M, et al. Gastrointestinal bleeding in children: diagnostic approach. Ital J Pediatr. 2024;50(1):13. Doi: https://doi.org/10.1186/s13052-024-01592-2
  3. Lanas A, Dumonceau JM, Hunt RH, et al. Non-variceal upper gastrointestinal bleeding. Nat Rev Dis Primers. 2018;4:18020. Doi: https://doi.org/10.1038/nrdp.2018.20
  4. Acharyya BC, Mukhopadhyay M, Chakraborty H. Changing trend in upper GI bleeding in children. Indian J Gastroenterol. 2023;42(4):562–568. Doi: https://doi.org/10.1007/s12664-022-01306-8
  5. Kocic M, Rasic P, Marusic V, et al. Age-specific causes of upper GI bleeding in children. World J Gastroenterol. 2023;29(47):6095–6105. Doi: https://dx.doi.org/10.3748/wjg.v29.i47.6095
  6. Kamboj AK, Hoversten P, Leggett CL. Upper GI bleeding: etiologies and management. Mayo Clin Proc. 2019;94(4):697–703. Doi: https://doi.org/10.1016/j.mayocp.2019.01.022
  7. Cappell MS, Friedel D. Initial management of acute upper GI bleeding. Med Clin North Am. 2008;92(3):491–509. Doi: https://doi.org/10.1016/j.mcna.2008.01.005
  8. Guglielmo FF, Wells ML, Bruining DH, et al. Gastrointestinal bleeding at CT angiography. Radiographics. 2021;41(6):1632–1656. Doi: https://doi.org/10.1148/rg.2021210043
  9. Sur LM, Armat I, Sur G, et al. Practical aspects of upper GI bleeding in children. J Clin Med. 2023;12(8):2921. Doi: https://doi.org/10.3390/jcm12082921
  10. Chun M, Vongsavath T, Sonaiya S, Liu L, Tun KM, Batra K, et al. A Systematic Review and Meta-Analysis on the Role of Somatostatin Therapy in Non-Variceal Gastrointestinal Bleeding. Gastroenterol. Insights 2025;16(2):18. Doi: https://doi.org/10.3390/gastroent16020018
  11. Al Lawati TT, Al Brashdi Y, Al Rahbi N, Omar I, Al Ismaili S. Sengstaken-Blakemore Tube: an extra mile. International Journal of Pediatrics and Adolescent Medicine. 2017 Dec 1;4(4):141-3. Doi: https://doi.org/10.1016/j.ijpam.2017.10.001
  12. Singhi S, Jain P, Jayashree M, Lal S. Approach to a child with upper GI bleeding. Indian J Pediatr. 2013;80(4):326–333. Doi: https://doi.org/10.1007/s12098-013-0987-x
  13. Chalabi DA. Upper Gastrointestinal Endoscopic Findings in Children at Rapareen Teaching Hospital in Erbil, Iraq. Med J Babylon. 2020;17(4):337–340. Doi: https://doi.org/10.4103/MJBL.MJBL_61_20
  14. Galos F, Ionescu MI, Mirea MDL, Boboc AA, Ioan A, Boboc C. Trends in upper GI bleeding in children. Antibiotics. 2024;13(8):752. Doi: https://doi.org/10.3390/antibiotics13080752
  15. Shahrebabak MG, Nezhad NZ, Azadmanesh MA, Shahpar A, Shahrebabak AG. Descriptive analysis of common causes of upper gastrointestinal bleeding in pediatric patients in Kerman: a study from 2022 to 2023. BMC gastroenterology. 2025 Mar 10;25(1):152. Doi: https://doi.org/10.1186/s12876-025-03750-016.
  16. Rafeey M, Shoaran M, Majidy H. Diagnostic endoscopy and clinical characteristics of gastrointestinal bleeding in children: a 10-year retrospective study. Iran Red Crescent Med J. 2013;15(9):794-7. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC3929813/
  17. Yu Y, Wang B, Yuan L, et al. Upper Gastrointestinal Bleeding in Chinese Children: A Multicenter 10-Year Retrospective Study. Clin Pediatr. 2016;55(9):838–843. Doi: https://doi.org/10.1177/0009922815611642
  18. Elhodhod MA, Hamdy AM, Fahmy PO, Awad YM. Diagnostic yield of esophagogastroduodenoscopy in upper gastrointestinal bleeding in pediatrics: a cross-sectional study at a tertiary center. Egypt Pediatr Assoc Gaz. 2023;71(1):6. Doi: https://doi.org/10.1186/s43054-022-00153-8
  19. Mazumder MW, Benzamin M. Upper GI bleeding in Bangladeshi children. World J Gastrointest Endosc. 2024;16(1):44–50. Doi: https://doi.org/10.4253/wjge.v16.i1.44
  20. Membreño-Ortíz G, Miranda-Barbachano K, Flores-Calderón J, González-Ortíz B, Siordia-Reyes G. Gastric vascular ectasia in children: Case reports. Rev Gastroenterol Mex. 2016;81(4):232–233. Doi: https://doi.org/10.1016/j.rgmxen.2016.02.002
  21. Lee YJ, Hwang J, Cho YH, Kim Y, Kim TU, et al. A long-Segmental Vascular Malformation in the Small Bowel Presenting With Gastrointestinal Bleeding in a Preschool-Aged Child. I J Radiol. 2016;13(1):e29260. Doi: https://doi.org/10.5812/iranjradiol.29260
  22. Cleveland K, Ahmad N, Bishop P, Nowicki M. Upper gastrointestinal bleeding in children: an 11-year retrospective endoscopic investigation. World Journal of Pediatrics. 2012 May;8(2):123-8. Doi: https://doi.org/10.1007/s12519-012-0350-8
  23. Voroniak DI, Godik OS, Fedoniuk LY, Shapoval OМ, Piliponova VV. Role of stage endoscopic variceal band ligation in treatment of children with portal hypertension. Wiad Lek. 2020;73(10):2133-2137. https://doi.org/10.36740/wlek202010105
  24. Kim SJ, Oh SH, Jo JM, Kim KM. Experiences with endoscopic interventions for variceal bleeding in children with portal hypertension: a single center study. Pediatr Gastroenterol Hepatol Nutr. 2013 Dec;16(4):248–253. Doi: https://doi.org/10.5223/pghn.2013.16.4.248
  25. Sami SS, Ragunath K. The Los Angeles Classification of Gastroesophageal Reflux Disease. Video J Encycl GI Endosc. 2013;1(1):103–104. Doi: https://doi.org/10.1016/S2212-0971(13)70046-3
  26. Devarapalli V, Poddar U, Srivastava A, Yachha SK. Efficacy of bougie versus balloon dilatation in children with benign esophageal stricture: a propensity score–matched retrospective cohort study. iGIE, 2023; 2(4), 495-502.e1. Doi: https://doi.org/10.1016/j.igie.2023.09.002
  27. Kakiuchi T, Obata S, Koji A, Minematsu N, Fuchigami M, Fukuta A, et al. Case Report: The importance of early intervention for gastroesophageal reflex disease caused by hiatal hernia. Front. Pediatr. 2004;12:1305585. Doi: https://doi.org/10.3389/fped.2024.1305585
  28. Jeong SJ, Lee J. Management of gastric outlet obstruction: Focusing on endoscopic approach. World J Gastrointest Pharmacol Ther 2020; 11(2): 8-16. Doi: https://doi.org/10.4292/wjgpt.v11.i2.8
  29. Miller A, Schwaitzberg S. Surgical and endoscopic options for benign and malignant gastric outlet obstruction. Current Surgery Reports. 2014 Mar 1;2(4):48. Doi: https://doi.org/10.1007/s40137-014-0048-z
  30. Olmos J, Marcolongo M, Pogorelsky V, Varela E, Dávolos JR. Argon plasma coagulation for prevention of recurrent bleeding from GI angiodysplasias. Gastrointestinal Endoscopy, 2004;60, 881-886. Doi: https://doi.org/10.1016/S0016-5107(04)02221-7
  31. Yeh P-J, Le P-H, Chen C-C, Chao H-C and Lai M-W. Application of Argon Plasma Coagulation for Gastrointestinal Angiodysplasia in Children— Experience From a Tertiary Center. Front. Pediatr. 2022;10:867632. Doi: https://doi.org/10.3389/fped.2022.867632
  32. Mistinova J, Valacsai F, Varga I. Congenital absence of the portal vein—case report and a review of literature. Clinical Anatomy. 2010 Oct;23(7):750-8. Doi: https://doi.org/10.1002/ca.21007
  33. Cipolletta L, Cipolletta F, Marmo C, Piscopo R, Rotondano G, Marmo R. Mechanical methods to endoscopically treat nonvariceal upper gastrointestinal bleeding: Review of the technique, indications and efficacy of mechanical methods including clips, OTSC and bands, to control upper GI bleeding. Techniques in Gastrointestinal Endoscopy. 2016;18(4):191-197. Doi: https://doi.org/10.1016/j.tgie.2016.12.009
  34. Di Nardo G, Esposito G, Mauro A, Zenzeri L, Ciccarelli GP, Catzola A, Rossi A, Domenico Corleto V. Dieulafoy lesion: two pediatric case reports. Ital J Pediatr. 2020;46:48. Doi: https://doi.org/10.1186/s13052-020-0814-8

Authors

Noor Barraq Albaqqal

1Department of Pediatrics, College of Medicine, University of Mosul, Mosul, Iraq.

ORCID
Adnan Mohammed Hasan

Identifiers

DOI: 10.33899/acmm.v48.i1.53806

Download this PDF file
PDF

Statistics

How to Cite

1.
Upper gastrointestinal bleeding in children: An 11-year retrospective analysis of clinico-endoscopic profile and management: Upper gastrointestinal bleeding. Ann. coll. Med. Mosul [Internet]. 2026 Jun. 30 [cited 2026 Jul. 18];48(1):53-8. Available from: https://mmed.uomosul.edu.iq/index.php/mmed/article/view/53806

How to Cite

1.
Upper gastrointestinal bleeding in children: An 11-year retrospective analysis of clinico-endoscopic profile and management: Upper gastrointestinal bleeding. Ann. coll. Med. Mosul [Internet]. 2026 Jun. 30 [cited 2026 Jul. 18];48(1):53-8. Available from: https://mmed.uomosul.edu.iq/index.php/mmed/article/view/53806