Endoscopic diagnosis in a Tunisian pediatric population with upper gastrointestinal bleeding.

Background: Esophagogastroduodenoscopy (EGD) is currently considered the first line diagnostic procedure chosen for Upper Gastrointestinal Bleeding (UGIB) since 1970. However, studies are still limited in our country.

Aim: Finding out the most common causes of UGIB in children and whether the causes differed according to age in developing and developed countries.

Methods: A retrospective review of the medical records of children referred to the Paediatric Gastroenterology Department of The Tunis Hospital of Children between January 1998 and December 2006 for upper gastrointestinal bleeding. The children were divided into three groups; G1: neonates; G2: infants; G 3: children and adolescents.

Results: The study involved 614 endoscopies. The aetiology was not ascertained in 20.68%of cases. G1 included 125 newborns: 24 with no identified causes, 97 mucosal lesions (isolated or associated); two ulcers and two tumours. G2 and G3 included respectively 205 infants and 289 children. Toxic drug intake was recorded in 140 out of 489 patients. Endoscopy was normal in 101 cases. Peptic oesophagitis was recorded in 57/205 (27.8%) of G2 infants versus 52/284 (10%) of G3 children (p=0.015). Gastritis was recorded in 164/284 (55.6%) of G2 infants versus 86/205 (41.9%) of G3 children (p≤0.001). Peptic ulcers were reported in ten boys. Mallory Weiss tears and Variceal lesions were found in respectively eleven and ten cases.

Conclusion: Aetiologies of UGIB in children in Tunisia varied according to age and geographic areas.