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Purpose of Review <p>Gastrointestinal (GI) bleeding in children is a high-stakes emergency department presentation whose etiological spectrum differs fundamentally from that of adults, shifting markedly across the neonatal, infant, toddler, and adolescent age groups. This narrative review synthesizes current evidence on the evaluation and management of pediatric upper and lower GI hemorrhage, presenting an age-stratified etiological framework spanning necrotizing enterocolitis in neonates to inflammatory bowel disease in adolescents, while critically appraising the adequacy of adult-derived diagnostic and risk-stratification tools when extrapolated to children.</p> Recent Findings <p>Fewer than 20% of evidence underlying pediatric GI bleeding guidelines derives from pediatric populations, and all major adult scoring instruments-Glasgow-Blatchford, Rockall, AIMS65-remain validated exclusively in adults despite their continued clinical use in children. The Sheffield score is the only pediatric-designed tool, yet it lacks prospective multicenter validation and endorsed numeric cutoffs. Diagnostic modalities including endoscopy, video capsule endoscopy (diagnostic yield 38–83%), and Meckel scintigraphy (sensitivity 77–85%) are reviewed alongside pharmacological and transfusion strategies, with persisting controversy over etiology-stratified transfusion thresholds, capsule endoscopy implementation, and optimal timing of endoscopic intervention.</p> Summary <p>Pediatric GI bleeding management remains constrained by extrapolation from adult evidence, underscoring an urgent need for validated, pediatric-specific risk scores and transfusion protocols stratified by etiology and hemodynamic status. Emerging tools-AI-assisted endoscopy, predictive risk modeling, and deep enteroscopy-offer promise but require pediatric-annotated training data and standardization before deployment. A structured research roadmap toward multicenter pediatric outcome registries is essential to close these gaps and improve outcomes for children with gastrointestinal hemorrhage.</p>

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Pediatric Gastrointestinal Bleeding: Emergency Department Evaluation and Management of Upper and Lower GI Hemorrhage

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年7月21日

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  • Khaled Abouelmagd,
  • Ahmed Bostamy Elsnhory,
  • Rashmika Mohunsing,
  • Mohanad Ghaleb,
  • Ursula Abu Nahla,
  • Karim Fahmy,
  • Sara Nalli,
  • Sarah Fakhiraldeen,
  • Muhammad Azan Shahid,
  • Mohammed Alsabri

摘要

Purpose of Review

Gastrointestinal (GI) bleeding in children is a high-stakes emergency department presentation whose etiological spectrum differs fundamentally from that of adults, shifting markedly across the neonatal, infant, toddler, and adolescent age groups. This narrative review synthesizes current evidence on the evaluation and management of pediatric upper and lower GI hemorrhage, presenting an age-stratified etiological framework spanning necrotizing enterocolitis in neonates to inflammatory bowel disease in adolescents, while critically appraising the adequacy of adult-derived diagnostic and risk-stratification tools when extrapolated to children.

Recent Findings

Fewer than 20% of evidence underlying pediatric GI bleeding guidelines derives from pediatric populations, and all major adult scoring instruments-Glasgow-Blatchford, Rockall, AIMS65-remain validated exclusively in adults despite their continued clinical use in children. The Sheffield score is the only pediatric-designed tool, yet it lacks prospective multicenter validation and endorsed numeric cutoffs. Diagnostic modalities including endoscopy, video capsule endoscopy (diagnostic yield 38–83%), and Meckel scintigraphy (sensitivity 77–85%) are reviewed alongside pharmacological and transfusion strategies, with persisting controversy over etiology-stratified transfusion thresholds, capsule endoscopy implementation, and optimal timing of endoscopic intervention.

Summary

Pediatric GI bleeding management remains constrained by extrapolation from adult evidence, underscoring an urgent need for validated, pediatric-specific risk scores and transfusion protocols stratified by etiology and hemodynamic status. Emerging tools-AI-assisted endoscopy, predictive risk modeling, and deep enteroscopy-offer promise but require pediatric-annotated training data and standardization before deployment. A structured research roadmap toward multicenter pediatric outcome registries is essential to close these gaps and improve outcomes for children with gastrointestinal hemorrhage.