Tiny Guts, Big Concerns: Know about GI Bleeding in Children

Types of GI bleeding in children

GI bleeding is mainly of 2 types:

• Upper GI Bleeding: Bleeding from ulcers and inflammation of the stomach, duodenum, or oesophagus lining causes upper GI bleeding. When this happens, the infant will throw up bright crimson blood or what appears to be “coffee grounds.'' Upper gastrointestinal haemorrhage can occasionally be accompanied by "melena", or black, sticky faeces.

• Lower GI Bleeding: The colon and the rectum are the most common sources of lower GI bleeding.

Typical reasons why GI bleeding in children occurs

1. Constipation: A child experiencing difficulty defecating or having irregular bowel movements puts extra stress on the GI tract, resulting in bleeding.

2. Ulcers: Ulcers are open sores formed on the inner lining of the GI tract, and if they erode, it results in GI bleeding.

3. A Meckel’s diverticulum: A Meckel’s diverticulum is a pouch, a little protrusion situated in the lower part of the small intestine, that extends from the intestinal wall. The bleeding is mainly caused by ulceration caused by the acid, which is secreted by specialised cells in this region.

4. Food allergies: Allergies to specific foods can cause hypersensitivity and, hence, GI bleeding.

5. Inflammatory bowel disease: It affects the lower gastrointestinal tract, which might cause bleeding. There are two types of IBD:

• Ulcerative colitis: The rectum's and colon's innermost linings are impacted by ulcerative colitis. This condition causes small ulcers on the lining of the large intestine, which may lead to bleeding, resulting in the appearance of blood in the stools.

• Crohn’s disease: Typically, Crohn's disease affects the beginning of the colon, also known as the cecum, and the end of the small intestine. Ulcers, fistulas, and fissures throughout the digestive system can result from Crohn's disease, which eventually causes bleeding.

Gastrointestinal Bleeding Symptoms in Children 

Some common GI bleed symptoms that the child might experience are:

• Abdominal cramps

• Bright red vomit

• Vomit that is dark brown or black and resembles coffee grounds

• Diarrhoea

• Fatigue

• Paleness, which can suggest iron-deficiency anaemia

• Shortness of breath

• Stool consistency that is tar-like, crimson, black, or dark brown

• Being inconsolable

• Uncontrollably bleeding from the mouth or anus

• A fever higher than 100.4 degrees Fahrenheit

• Dehydration symptoms, such as dry mouth, extreme thirst, etc

• Dizziness, lightheadedness, unresponsiveness, or extreme lethargy

What can you spot?

• Vomiting of bright red blood from the mouth, in case of active bleeding, or coffee-ground coloured material, in case of old bleeding.

• Black and foul-smelling stool emission from the anus.

• Passage of bright red or dark blood via the rectum.

• Visible blood flow whose source has not been determined by radiological or endoscopic analysis.

• Passage of not-visible blood suggested by laboratory tests was confirmed by a positive faecal occult blood test.

Diagnosis of GI bleeding

Blood that has been swallowed might be mistaken for gastrointestinal bleeding at any age. Blood can be consumed by newborns directly from the breast or through breastfeeding when the mother is bleeding nearby. Blood from an intraoral or nosebleed can be mistaken for gastrointestinal bleeding if it is swallowed and causes haematemesis, which is characterised by blood in the vomit. Even though foods and beverages may contain red dye that causes the stool to turn red, an occasional blood test will reveal that the stool is heme-negative. ³

1. Complete blood count

2. Plain abdominal X-ray 

3. Ultrasonography (USG) of the abdomen

4. Abdominal CT scans and MRIs are useful to determine the intra-abdominal vasculature.

5. Meckel's scan could be performed to explore Meckel's diverticulum.

Treatment

There’s a different treatment approach for GI bleeding for upper GI bleeding and lower GI bleeding, which includes, 

• Drugs like Zantac, Pepcid, Prevacid, Prilosec, etc., that lower stomach acid, are used to manage upper GI bleeding while the lining recovers. 

• The origin and location of lower gastrointestinal bleeding determine how to manage it. If the bleeding indicates a polyp or a diagnosis of colitis is suspected, a Colonoscopy will be advised as the most effective method of identifying the origin of lower GI bleeding. During this examination, a flexible fibre optic tube equipped with a camera system enables a direct view of the rectum and may be moved throughout the large intestine. During the Colonoscopy, samples can be obtained for diagnosis or culture, and polyps can be removed with specialised snares.

Conclusion

Parents may become anxious when their infant or child experiences gastrointestinal bleeding. Some illnesses could be mistaken for gastrointestinal bleeding. When their GI tract bleeds, most kids get better quickly. More severe and recurrent bleeding episodes can occur in those with certain liver or coagulation disorders. In the most serious situations, surgery or blood transfusions may be necessary. It is very helpful to identify GI bleeding early on so that the child can receive successful treatment. For paediatric GI bleeding, Manipal Hospitals, Kolkata, ensures a precise and accurate diagnosis along with the best possible care.