Aggiornamento
Il sanguinamento gastrointestinale
GASTROINTESTINAL BLEEDING
CLAUDIO ROMANO
Gastroenterologia ed Endoscopia Digestiva, UO di Pediatria, Ospedali Riuniti di Reggio Calabria
Febbraio 2004 - pagg. 86 -93
Abstract
Among the paediatric emergencies, gastroenterologic conditions have a prominent role. The
most frequent are acute abdominal pain, intractable vomiting, foreign body ingestion, caustic
ingestion and gastrointestinal bleeding, this last being the one that usually generates the
greatest concern. The presenting features can vary: blood loss from the gastrointestinal tract
can become manifest as hematemesis, melena, hematochezia and/or occult bleeding. A careful
and well focused history taking and physical examination are essential for the initial evaluation,
as they provide clues to the etiology and help assessing the severity of bleeding and
determining the anatomical location of the bleeding. The Authors describe the appropriate case-
management of gastrointestinal bleeding in children by presenting a few clinical cases.
Parole chiave
Suggerite dall'AI
Classificazione MeSH
Bibliografia
1. Kassem AM. Gastrointestinal Bleeding. Endoscopy
2000;32:25-8.
2. Jonathan P. Terdiman. Colonscopic management of lower gastrointestinal hemorrhage. Current Gastroenterology Report 2001; 3:425-32.
3. Scaillon M, Cadranel S. Safety data required for proton-pump inhibitor use in children. J Pediatr Gastroenterol Nutr 2002;35(2):113-20.
4. Groszmann RJ, Garcia-Tsao G, et al. Endoscopic variceal banding vs. pharmacological therapy for the prevention of recurrent variceal hemorrhage: what makes the difference? Gastroenterology 2002;123(4):388-9.
5. Zetting G, et al. The importance of delayed images in gastrointestinal bleeding scintigraphy. Nucl Med Commun 2002;23(8):803-8.
6. Christopher J. Gostout. Pharmacotherapy of acute non-variceal bleeding. Dig Dis 1998; 16:263-5.
7. Miga D, Sokol RJ, MacKenzie T, et al. Survival after first esophageal variceal hemorrhage in patients with biliary atresia. J Pediatr 2001;139:291-6.
8. Lykavieris P, Gaurhier F, Hadchouel P, et al. Risk of gastrointestinal bleeding during adolescence and early adulthood in children with portal vein obstruction. J Pediatr 2000; 136:805-8.
9. Howard ER, Stringer MD, Mowat AP. Assessment of injection sclerotherapy in the management of 152 children with oesophageal varices. Br J Surg 1988:75;404-8.
10. Sarin SK, Misra SP, Singal AK, et al. Endoscopic sclerotherapy for varices in children. J Pediatr Gastroenterol Nutr 1988;7:662-6.
11. Ozsoylu S, Kocak N, Yuce A. Propanolol therapy for portal hypertension in children. J Pediatr 1985:106:317-21.
12. Shashidar H, Langhans N, Grand RJ. Propanolol in prevention of portal hypertensive hemorrhage in children: a pilot study. J Pediatr Gastroenterol Nutr 1999;29:12-7.
13. Paquet K-J. Ten years experience with paravariceal injection sclerotherapy of esophageal varices in children. J Pediatr Surg 1985; 20:109-12.
14. Imperiale TF, Chalasani N. A meta-analysis of endoscopic variceal ligation for primary prophylaxis of esophageal variceal bleeding. Hepatology 2001; 33:802-7.
15. Hill ID, Bowie MD. Endoscopic sclerotherapy for control of bleeding varices in children. Am J Gastroenterol 1991;86:472-6.
16. Karrer FM, Holland RM, Allshouse MJ, et al. Portal vein thrombosis: treatment of variceal hemorrhage by endoscopic variceal ligation. J Pediatr Surg 1994;29:1149-51.
17. Patch D, Sabin CA, Goulis J, et al. A randomized, controlled trial of medical therapy versus endoscopic ligation for the prevention of variceal rebleeding in patients with cirrhosis. Gastroenterology 2002:123:1013-9.
18. Zargar SA, et al. Endoscopic ligation compared with sclerotherapy for bleeding esophageal varices in children with extrahepatic portal venous obstruction. Hepatology 2002;36 (3):666-72.
19. Spiegel BM, et al. The effectiveness of early endoscopy for low- risk patients with non-variceal upper gastrointestinal hemorrhage (UGIH): a systematic review. Gastroenterology 2000;118:A218.
20. Richard S, et al. Diagnosis and management for lower gastrointestinal bleeding. Current Opinion in Gastroenterology 2000; 16:89-97.
21. Corredor J, et al. Gastrointestinal polyps in children: advances in molecular genetics, diagnosis, and management. Pediatrics 2001; 138 (5):26-8.
22. Amitabh Chark, et al. Effectiveness of endoscopy in patients admitted to the intensive care unit with upper GI hemorrhage. Gastrointestinal Endoscopy 2001;53(1).
23. Chung YFA, et al. Diagnostic failures in endoscopy for acute upper gastrointestinal haemorrhage. British Journal of Surgery 2000;87: 614-7.
24. Marek TA. Gastrointestinal Bleeding. Endoscopy 2001;33(11):920-9.
25. Lee KH, Yelung CK, Tam YH, et al. Laparoscopy for definitive diagnosis and treatment of gastrointestinal bleeding of obscure origin in children. J Pediatr Surg 2000;9:1291-3.
2. Jonathan P. Terdiman. Colonscopic management of lower gastrointestinal hemorrhage. Current Gastroenterology Report 2001; 3:425-32.
3. Scaillon M, Cadranel S. Safety data required for proton-pump inhibitor use in children. J Pediatr Gastroenterol Nutr 2002;35(2):113-20.
4. Groszmann RJ, Garcia-Tsao G, et al. Endoscopic variceal banding vs. pharmacological therapy for the prevention of recurrent variceal hemorrhage: what makes the difference? Gastroenterology 2002;123(4):388-9.
5. Zetting G, et al. The importance of delayed images in gastrointestinal bleeding scintigraphy. Nucl Med Commun 2002;23(8):803-8.
6. Christopher J. Gostout. Pharmacotherapy of acute non-variceal bleeding. Dig Dis 1998; 16:263-5.
7. Miga D, Sokol RJ, MacKenzie T, et al. Survival after first esophageal variceal hemorrhage in patients with biliary atresia. J Pediatr 2001;139:291-6.
8. Lykavieris P, Gaurhier F, Hadchouel P, et al. Risk of gastrointestinal bleeding during adolescence and early adulthood in children with portal vein obstruction. J Pediatr 2000; 136:805-8.
9. Howard ER, Stringer MD, Mowat AP. Assessment of injection sclerotherapy in the management of 152 children with oesophageal varices. Br J Surg 1988:75;404-8.
10. Sarin SK, Misra SP, Singal AK, et al. Endoscopic sclerotherapy for varices in children. J Pediatr Gastroenterol Nutr 1988;7:662-6.
11. Ozsoylu S, Kocak N, Yuce A. Propanolol therapy for portal hypertension in children. J Pediatr 1985:106:317-21.
12. Shashidar H, Langhans N, Grand RJ. Propanolol in prevention of portal hypertensive hemorrhage in children: a pilot study. J Pediatr Gastroenterol Nutr 1999;29:12-7.
13. Paquet K-J. Ten years experience with paravariceal injection sclerotherapy of esophageal varices in children. J Pediatr Surg 1985; 20:109-12.
14. Imperiale TF, Chalasani N. A meta-analysis of endoscopic variceal ligation for primary prophylaxis of esophageal variceal bleeding. Hepatology 2001; 33:802-7.
15. Hill ID, Bowie MD. Endoscopic sclerotherapy for control of bleeding varices in children. Am J Gastroenterol 1991;86:472-6.
16. Karrer FM, Holland RM, Allshouse MJ, et al. Portal vein thrombosis: treatment of variceal hemorrhage by endoscopic variceal ligation. J Pediatr Surg 1994;29:1149-51.
17. Patch D, Sabin CA, Goulis J, et al. A randomized, controlled trial of medical therapy versus endoscopic ligation for the prevention of variceal rebleeding in patients with cirrhosis. Gastroenterology 2002:123:1013-9.
18. Zargar SA, et al. Endoscopic ligation compared with sclerotherapy for bleeding esophageal varices in children with extrahepatic portal venous obstruction. Hepatology 2002;36 (3):666-72.
19. Spiegel BM, et al. The effectiveness of early endoscopy for low- risk patients with non-variceal upper gastrointestinal hemorrhage (UGIH): a systematic review. Gastroenterology 2000;118:A218.
20. Richard S, et al. Diagnosis and management for lower gastrointestinal bleeding. Current Opinion in Gastroenterology 2000; 16:89-97.
21. Corredor J, et al. Gastrointestinal polyps in children: advances in molecular genetics, diagnosis, and management. Pediatrics 2001; 138 (5):26-8.
22. Amitabh Chark, et al. Effectiveness of endoscopy in patients admitted to the intensive care unit with upper GI hemorrhage. Gastrointestinal Endoscopy 2001;53(1).
23. Chung YFA, et al. Diagnostic failures in endoscopy for acute upper gastrointestinal haemorrhage. British Journal of Surgery 2000;87: 614-7.
24. Marek TA. Gastrointestinal Bleeding. Endoscopy 2001;33(11):920-9.
25. Lee KH, Yelung CK, Tam YH, et al. Laparoscopy for definitive diagnosis and treatment of gastrointestinal bleeding of obscure origin in children. J Pediatr Surg 2000;9:1291-3.