Pediatric gastrointestinal bleeding: Perspectives from the Italian Society of Pediatric Gastroenterology

Table 1 Definitions

Upper gastrointestinal bleeding	GI bleeding originating proximal to the ligament of Treitz (esophagus, stomach and duodenum)
Lower gastrointestinal bleeding	GI bleeding originating distal to the ligament of Treitz (small bowel and colon)
Occult gastrointestinal bleeding	GI bleeding that is not visible to the patient or physician, resulting in either a positive fecal occult blood test or iron-deficiency anemia
Hematemesis	Vomiting of blood or coffee-ground-like material
Hematochezia	Passage of fresh blood per anus
Melena	Passage of black, tarry stools per anus

GI: Gastrointestinal.

Table 2 Causes of upper gastrointestinal bleeding based on age

	Infants	2-5 years	Older
Esophagus		Esophagitis	Esophagitis
		Esophageal varices	Mallory-Weiss syndrome
		Mallory-Weiss syndrome	Esophageal varices
Stomach	Gastritis from stress	Gastritis	Dieulafoy lesion
		Gastric ulcer	PHG
		Gastric varices	Hemobilia
Duodenum		Duodenitis
		Duodenal ulcer
Variable location	Vitamin K deficiency	Caustic ingestions	Polyps
	Sepsis	Foreign bodies	Crohn’s disease
	Trauma (NG tubes)	NSAIDs use	Telangiectasia
	CMPA		Aortoenteric fistula
			Coagulation disorders
			Caustic ingestions
			Foreign bodies
			NSAIDs use

NG: Nasogastric; CMPA: Cow's milk protein allergy; NSAIDs: Non-steroidal anti-inflammatory drugs; PHG: Portal hypertensive gastropathy.

Table 3 Causes of lower gastrointestinal bleeding based on age

Infants	2-5 years	Older
Non-specific colitis	Polyps	Anal fissure
Anal fissure	Anal fissure	Infectious Enterocolitis
Milk allergy	Infectious enterocolitis	Polyps
Duplication of bowel	Intussusception	Inflammatory bowel disease
Volvulus	Meckel’s diverticulum	Lymphonodular hyperplasia
Hirschsprung’s disease	Henoch-Schonlein purpura	Henoch-Schonlein purpura
Necrotizing enterocolitis	Hemolytic-uremic syndrome	Angiodysplasia
Bleeding diathesis	Lymphonodular hyperplasia	Hemolytic-uremic syndrome
	Angiodysplasia	Bleeding diathesis