{
  "abstract": "UGIB is a potentially life-threatening event, defined as bleeding from above the fourth part of the duodenum manifesting as haematemesis, coffee-ground vomiting or melaena. 1 It is rare in the paediatric population with causes varying by age. Many guidelines are extrapolated from adult guidelines.2 3 BSPGHAN produced a regional pathway for UGIB in 2018.4 This review describes aetiology and management of UGIB in children in a single tertiary centre across an eighteen-month period.Data was gathered by searching electronic patient discharges for coded diagnoses of ‘upper gastrointestinal bleed’, ‘upper gastrointestinal haemorrhage’, ‘haematemesis’, ‘coffee ground vomit’ or ‘melaena’. Handover lists were also analysed. Patients aged sixteen or under with signs of UGIB were included; those with only LGIB (fresh rectal bleeding) were excluded.35 children were identified. 15/35 presented to the tertiary centre emergency department, 15/35 were transferred from district general hospitals (DGH), 4/35 were current inpatients or day-case patients and 1/35 was undocumented. 21/35 had significant co-morbidities; 9/21 had known GI conditions. 17/35 presented with minor bleeding without haemoglobin drop; 18/35 had significant bleeding with haemoglobin drop or low haemoglobin on admission requiring transfusion.The majority had documented A to E assessments and were kept nil by mouth but investigations performed differed. Most children (33/35) did not have a chest x-ray or documented consideration of button battery ingestion. 12 did not have a full blood work up, with clotting studies most commonly missing (7/12). Most received intravenous (IV) omeprazole and 10/35 received IV tranexamic acid. 11/35 were given IV antibiotics without documentation of indication.19/35 underwent endoscopy, 7/35 are awaiting endoscopy, 4/35 had other causes identified and 5/35 had minor bleeding and were discharged without follow up. 3/35 patients required endoscopic intervention including adrenaline, polypectomy and flouracil with balloon tamponade.Causes identified for UGIB are summarised in table 1.Abstract OC74 Table 1causes for UGIBSignificant GI pathology 8 Liver disease with portal hypertension 1 In context of other acute illness 2 Post endoscopy 2 Irritation from gastro-jejunal tube 2 Gastritis H pylori positive H pylori negative 2 8 Mallory Weiss tear 4 Other 6 Significant GI pathology included a gastrointestinal stromal tumour (1), Meckel’s diverticulum (2), Peutz-Jegher polyposis (1), gastric ulcer (1), duodenal ulcer (2), severe oesophagitis (1). ‘Other’ included swallowed maternal blood, self-induced, and minor bleeds.Limitations of this study were the retrospective nature and small numbers. The presentation and causes for UGIB in paediatric patients remains broad. Although rare, significant GI pathology should remain in the differential. Around half presented with significant bleeding requiring transfusion. However, since the need for endoscopic intervention is uncommon, adult Gastroenterology and surgeons may be required to support endoscopic therapy.Numerous presentations at DGHs show education and network management is vital to support paediatricians in the stabilisation and management of UGIB. Although no patients had ingested a button battery, documentation of this consideration was inadequate. This is vital due to the associated morbidity and mortality. Documentation of clinical reasoning for utilising different medications for UGIB remains an issue, within and without gastroenterology.References Galos F, Ionescu MI, Mirea MDL, et al. Trends in upper gastrointestinal bleeding in children: the impact of helicobacter pylori infection and non-steroidal anti-inflammatory drug use. Antibiotics 2024;13(8).Nasher O, Devadason D, Stewart RJ. Upper gastrointestinal bleeding in children: a tertiary United Kingdom children’s hospital experience. Children 2017;4(11).UHL Children’s quality and Safety Board. Management of Upper Gastrointestinal bleeding in children. 2023. Available from: https://secure.library.leicestershospitals.nhs.uk/PAGL/Shared%20Documents/Upper%20Gastrointestinal%20Bleeding%20UHL%20Childrens%20Guideline.pdf. Accessed 21/10/2024.BSPGHAN. GI bleeding pathway. 2018",
  "authors": [
    {
      "affiliations": [
        "Department of Paediatric Gastroenterology, RMCH"
      ],
      "name": "Catherine Acton"
    },
    {
      "affiliations": [
        "Department of Paediatric Gastroenterology, RMCH"
      ],
      "name": "Maureen Lawson"
    },
    {
      "affiliations": [
        "Department of Paediatric Gastroenterology, RMCH"
      ],
      "name": "Loveday Jago"
    },
    {
      "affiliations": [
        "Department of Paediatric Gastroenterology, RMCH"
      ],
      "name": "Adnaan Kala"
    },
    {
      "affiliations": [
        "Department of Paediatric Gastroenterology, RMCH"
      ],
      "name": "Andrew Fagbemi"
    },
    {
      "affiliations": [
        "Department of Paediatric Gastroenterology, RMCH"
      ],
      "name": "Virginia Chatzidaki"
    },
    {
      "affiliations": [
        "Department of Paediatric Gastroenterology, RMCH"
      ],
      "name": "Chai Lee"
    },
    {
      "affiliations": [
        "Department of Paediatric Gastroenterology, RMCH"
      ],
      "name": "Sian Copley"
    }
  ],
  "title": "OC74 Characteristics and management of upper gastrointestinal bleeding (UGIB) in a tertiary paediatric gastroenterology centre: a retrospective review",
  "uid": "7278ed58-d40e-540f-b58f-2f35abf39659"
}