Duodenal ulcers dominate acute upper gastrointestinal tract bleeding in childhood: a 10-year experience from Hong Kong

OBJECTIVE: Systematic reports on acute upper gastrointestinal bleeding in children/adolescents are scanty. The aim of this study is to analyze its presentation, pathology and outcome in Hong Kong. METHODS: A retrospective review of the hospital database for admissions up to the age of 18 years with signs of acute upper gastrointestinal bleeding between 1 June 1996 and 31 May 2006. RESULTS: During the 10‐year period 76 patients (55 boys) were admitted with signs of upper gastrointestinal bleeding. The median age was 13.5 (range 0.25–18) years. Melena and hematemesis were by far the most frequent presentations. Medication was implicated in 16 cases (21%) as the possible cause for the bleeding. Endoscopic findings were a duodenal ulcer in 57 (75%) patients (50 boys) and a gastric ulcer in eight (10.5%). Helicobacter pylori infection was identified in 42 (55%) patients, of which 38 were found in duodenal ulcer patients. Eleven patients (14.5%) had interventions to achieve hemostasis: six epinephrine spray only, three thermal probe and two vessel ligation. After a median follow‐up time of 3.5 years six patients had a recurrent duodenal ulcer. Three patients died of unrelated illnesses. CONCLUSION: Acute upper gastrointestinal tract bleeding in children and adolescents in Hong Kong is dominated by a duodenal ulcer in 75% of the patients. Acute bleeding is more frequent in boys (boy to girl ratio 2.6:1). Medication is a predisposing factor in 20% of the bleedings. Six patients (8%) have recurrent duodenal ulcers.