Endoscopic Findings and Associated Factors in Children with Hematemesis

Background Gastrointestinal bleeding (GIB) and especially upper GIB in children under 18 years, is underestimated compared to the adult population. Although mortality rate in this group of patients is reported to be about 2 percent, the role of early endoscopy in diagnosis and treatment of underlying causes and prevention of recurrence is essential. We aimed to evaluate endoscopic findings in children with hematemesis and assess the relationships between these findings and demographic/clinical variables. Materials and Methods: In this cross-sectional study, we have studied the medical records of 102 patients from November 2017 to November 2018, under 18 years who referred to Children’s Medical Center with hematemesis and had undergone the endoscopic procedure. The demographic information, past medical history, history of using NSAIDs (Non-Steroidal Anti-inflammatory Drugs), accompanying symptoms, laboratory records, and endoscopic findings were investigated. Results: Participants are mostly between 6-11 years old (52.9%, n=54). The most common accompanying symptom is non-bleeding vomiting (52%, n=51). Patients with a history of using NSAIDs had a significantly higher rate of gastric ulcers (P-value<0.05). Moreover, the patients with a positive history of vomiting had a higher duodenal ulcer rate (P-value<0.05). Hb levels are significantly lower in patients with esophagitis (P-value<0.05). Also, patients with antrum nodularity were significantly older (P-value<0.05). Conclusion Prolapse gastropathy and gastric ulcers are the most common finding in endoscopy of children <18 years old with hematemesis. Also, the recent use of NSAIDs is the cause of gastric ulcers, and vomiting is related to duodenal ulcers. It is necessary to control recurrent vomiting and to limit the use of NSAIDs in children to prevent GI bleeding.