Huang I-Fei, Wu Tzee-Chung, Wang Ke-Sheng, Hwang Betau, Hsieh Kai-Sheng
Department of Pediatrics, Kaohsiung Yeterans General Hospital, Taiwan, ROC.
J Chin Med Assoc. 2003 May;66(5):271-5.
The purpose of this study was to evaluate the clinical presentations and features of upper gastrointestinal (UGI) endoscopy and the role of Helicobacter pylori in children with UGI bleeding.
A retrospective review was done of the medical records of 112 infants and children who presented with UGI bleeding. They underwent UGI endoscopy in the Taipei Veterans General Hospital, Taiwan between July 1996 and December 2000. Patients with hematemesis caused by swallowing caustic agents or foreign bodies were excluded.
There were 112 patients involved in this study. Clinical manifestations included hematemesis (77 cases, 68.8%), tarry stool (37 cases, 33%) and hematochezia (9 cases, 8%). Fifty-three patients (47.3%) had underlying diseases, including neuromuscular deficits (17), hepatobiliary disease (17), renal insufficiency (8), Henoch-Schonlein purpura (HSP) (3), and cow milk allergy (3). Another 34 patients had a preceding acute febrile illness history. The endoscopic appearances included esophageal varices (10.7%), esophagitis or esophageal ulcers (30.4%), superficial gastric mucosal lesions (SGML) (44.6%), gastric ulcers (9.8%), duodenal ulcers (DU) (15.2%), and hemorrhagic erosive duodenitis (2.7%). Eleven cases (9.8%) showed negative findings. There were 13 (11.6%) patients receiving endoscopic hemostatic therapy. The rate of positive results in rapid urease tests in the patients without underlying diseases was 54.8%, which was significantly higher than that of the patients with underlying diseases (17.1%), while Helicobacter pylori was closely related to primary DU.
In children with UGI bleeding, UGI endoscopy provides an accurate diagnostic tool and also provides therapeutic intervention when needed. SGML was the most common endoscopic finding. About 30% of the infants and children with UGI bleeding had history of acute febrile illness. Half of the children had underlying diseases. Helicobacter pylori plays a role in a subgroup of children with UGI bleeding, particularly in children with primary DU.
本研究旨在评估上消化道（UGI）内镜检查的临床表现及特征，以及幽门螺杆菌在儿童上消化道出血中的作用。
对112例出现上消化道出血的婴幼儿及儿童的病历进行回顾性分析。他们于1996年7月至2000年12月期间在台湾台北荣民总医院接受了上消化道内镜检查。排除因吞食腐蚀性物质或异物导致呕血的患者。
本研究共纳入112例患者。临床表现包括呕血（77例，68.8%）、黑便（37例，33%）及便血（9例，8%）。53例患者（47.3%）有基础疾病，包括神经肌肉功能缺陷（17例）、肝胆疾病（17例）、肾功能不全（8例）、过敏性紫癜（HSP）（3例）及牛奶过敏（3例）。另外34例患者有前驱急性发热病史。内镜表现包括食管静脉曲张（10.7%）、食管炎或食管溃疡（30.4%）、浅表胃黏膜病变（SGML）（44.6%）、胃溃疡（9.8%）、十二指肠溃疡（DU）（15.2%）及出血性糜烂性十二指肠炎（2.7%）。11例（9.8%）检查结果为阴性。13例（11.6%）患者接受了内镜止血治疗。无基础疾病患者的快速尿素酶试验阳性率为54.8%，显著高于有基础疾病的患者（17.1%），而幽门螺杆菌与原发性DU密切相关。
对于儿童上消化道出血，上消化道内镜检查是一种准确的诊断工具，必要时还可提供治疗干预。SGML是最常见的内镜表现。约30%的儿童上消化道出血患者有急性发热病史。半数儿童有基础疾病。幽门螺杆菌在部分儿童上消化道出血中起作用，尤其是原发性DU患儿。
