الفهرس 
ACKNOWLEDGMENTOnly 14 pages are availabe for public view
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Abstract
Gastrointestinal bleeding (GIB) in infant and children is one of the most alarming conditions encountered in pediatrics. It is nonetheless an anxiety-provoking complaint . Most etiologies are self-limited and benign, 75% to 85% of GI bleeding ceases spontaneously, but some are potentially serious leading to hemodynamic compromise that requires aggressive resuscitation and intervention.
There is considerable overlap between age groups and causes of UGIB, however of all cases of UGIB in children 95% are related to mucosal lesions and esophageal varices. Mucosal lesions, including esophagitis, gastritis, stress ulcer, peptic ulceration .
A detailed history and physical examination along with limited laboratory studies may identify the underlying cause and predict the severity of gastrointestinal bleeding. Assessment should be made regarding the presence and severity of hematemesis.
Therapeutic intervention is based on the cause of bleeding, this is done after proper assessment of the patient, hemodynamic status and initiation of appropriate resuscitation measures .
The present study that performed in pediatric gastroenterology , emergency and neonatal ICU units at Sohag university hospital from January to December, 2017 .
In this study we planned to evaluate cases of hematemesis in pediatric patients as regard causes and the outcome according to the causes, age of the patient and treatment received.
It included sixty two patients who presented by hematemesis or bloody gastric aspirate.
Summary
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In our study male to female ratio was insignificant . The study included children from one day up to twelve years old. The most common age group is from six to twelve years old .
The most common cause of UGIB is GERD (37.1%) followed by gastritis (32.3%) then bleeding tendencies (21%), esophagitis (16.1%). Esophageal varices was the cause in (12.9%) of cases. Peptic ulcer accounted for 6.5% of causes of hematemesis.
Thirteen neonates included in our study, were admitted to NICU and developed hematemesis or bloody or brownish gastric aspirate.
The most common cause in this age group was thrombocytopenia and DIC (14.5%) which developed due to neonatal sepsis followed by hemorrhagic disease of new born (4.8%) .
In our study we found that family history of UGIB present in two cases (3.2%). 6.5% of patients had history of drug intake before developing upper GI bleeding all of them had received NSAIDs .
Upper GI endoscopy is a safe and a useful mode of investigation in cases of hematemesis in children, it was done for 69.9% of cases, it diagnosed the etiology in all cases except one which was a case of bleeding tendency .
In 82.3% of patients hematemesis stopped and not recur again on medical treatment, 28.5% of patients received fresh frozen plasma (FFP) and platelets and only one case needed blood transfusion .
There is recurrence of bleeding in 10.9% of cases of UGIB only .
During the study, there are four deaths in case of UGIB , all deaths were seen in patients who had massive and multiple episodes of hematemesis.
Conclusion
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Conclusion
We concluded that UGIB is more common in 6 – 12 years age group with hematemesis as the main presenting symptom.
There is significant relation between cases of hematemesis in age group less than one month (neonates) was thrombocytopenia which occur due neonatal sepsis as it was the cause in 9 (69.2%) of patients of this age group followed by hemorrhagic disease of new born in 3 (23.1%) of cases, one case was bleeding tendency due to unknown cause .
In patients aged from one month up to one year, GERD was the most common cause of UGIB as it was the cause in 5 (45.5%) of cases, followed by esophagitis, gastritis and bleeding tendency by 2 (18.2%) for each cause. Esophageal varices was the cause in one (9.1%) of cases.
GERD was also the most common cause in patients of age group from one year up to six years as it is the cause in 11 (64.7%) of patients, followed by gastritis in 7 (41.2%) of cases .
In patients from 6 years up to 12 years the most common cause was gastritis as it was the cause in 11 (52.4%) of cases. Second most common causes were gastritis and esophageal varices by 7 (33.3%) of cases, followed by esophagitis and bleeding tendency by 2 (9.5%) of cases of gastritis were associated with deudenitis.