By DR AMORNPHUN GAENSAN
Upper gastrointestinal bleeding (UGIB) is bleeding that occurs in your child’s upper gastrointestinal tract.
The bleeding occurs in the oesophagus, stomach or duodenum, the first part of the small intestine, and is often caused by stress ulcers or gastritis as a result of the child suffering from a severe illness. In short, when a child’s body is put under stress due to illness, it releases an acid that can lead to bleeding in the stomach. Stress ulcers resulting in UGIB are common among children in the Neonatal Intensive Care Unit (NICU) or the Paediatric Care Unit (PICU)
Another cause, especially in older children, is a peptic ulcer. Symptoms of peptic ulcer include abdominal pain and vomiting up blood.
Other reasons for the bleeding include multiple episodes of severe vomiting which can cause a tear or an inflammation in the oesophagus; food allergies, haemorrhagic disease, liver dysfunction; vascular malformation and variceal bleeding. In the past vitamin K deficiency was also to blame though this is no longer one of the most common causes of UGIB due to vitamin injections every newborn must receive.
It should be noted that sometimes a child might appear to have UGIB, but other factors are at play. For example, a child may swallow some of their mother’s blood during breastfeeding, causing the child to have a bloody mouth. Mothers will often be alarmed, thinking the blood is coming from the child.
Before rushing to the hospital, the mother should check if her nipples are cracked and/or bleeding.
One obvious symptom of gastrointestinal bleeding is vomiting blood. Other symptoms may include fatigue, pale skin, shortness of breath, and abdominal pain that is more painful than usual. Some children may show no signs of UGIB. In severe cases, one of the signs of UGIB is black stool.
UGIB can be detected through a blood test showing whether or not someone has a low level of haemoconcentration. If left untreated, gastrointestinal bleeding can be fatal, so detecting it as early as possible is of utmost importance.
Take your child to the doctor immediately if he/she is vomiting blood or black material that looks like coffee grounds or has black and tarry or maroon stools. Early detection is key: the sooner gastrointestinal bleeding is diagnosed or ruled out, the sooner your child’s condition can improve rapidly, allowing for a happy, healthy life.
Most commonly, a physical exam will be performed. In some cases, the doctor may perform a gastroscopy in which a small tube inserted through the mouth to determine the source of the bleeding and evaluate its severity.
An abdominal and rectal examination may also be performed to determine the cause of the bleeding. Other tests are carried out to determine the complete blood count, the patient’s liver function, and the blood’s ability to clot (coagulation test).
Treatment depends on the condition your child has, and how much bleeding has taken place. The following are some of the treatments your child’s doctor may perform:
Administering medicine to reduce stomach acid in the cases of peptic ulcers or stress ulcers
Removing certain foods from your child if he or she has food allergies
Therapeutic endoscope to stop the bleeding in more severe cases
Direct treatment of the wounds inside the child’s stomach
DR AMORNPHUN GAENSAN is a specialist in Paediatric Gastroenterology and Hepatology at the Samitivej International Children’s Hospital, Sukhumvit Campus. Call (02) 022 2236-7.