Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 28, 2017; 23(8): 1328-1337
Published online Feb 28, 2017. doi: 10.3748/wjg.v23.i8.1328
Pediatric gastrointestinal bleeding: Perspectives from the Italian Society of Pediatric Gastroenterology
Claudio Romano, Salvatore Oliva, Stefano Martellossi, Erasmo Miele, Serena Arrigo, Maria Giovanna Graziani, Sabrina Cardile, Federica Gaiani, Gian Luigi de’Angelis, Filippo Torroni
Claudio Romano, Unit of Pediatrics, Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University of Messina, 98125 Messina, Italy
Salvatore Oliva, Department of Pediatrics and Infantile Neuropsychiatry, Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, 00161 Rome, Italy
Stefano Martellossi, Institute for Maternal and Child Health IRCCS ‘Burlo Garofalo’, 34137 Trieste, Italy
Erasmo Miele, Department of Translational Medical Science, Section of Pediatrics, University of Naples “Federico II”, 80131 Naples, Italy
Serena Arrigo, Gastroenterology and Endoscopy Unit, G. Gaslini Children’s Hospital-IRCCS, 16147 Genoa, Italy
Maria Giovanna Graziani, Gastroenterology and Endoscopy Unit, “San Giovanni Addolorata” Hospital, 00184 Rome, Italy
Sabrina Cardile, Hepatology, Gastroenterology and Nutrition Unit, Bambino Gesù Children’s Hospital, 00165 Rome, Italy
Federica Gaiani, Gian Luigi de’Angelis, Gastroenterology and Endoscopy Unit, University of Parma, 43126 Parma, Italy
Filippo Torroni, Department of Surgery and Transplantation, Digestive Surgery and Endoscopy Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
Author contributions: Romano C and Torroni F contributed substantially to the study conception and design; Oliva S, Martellossi S, Miele E, Arrigo S, Graziani MG, Cardile S and de’Angelis GL conducted the literature search and drafted the manuscript; all the authors approved the final manuscript and agree to be accountable for all aspects of the work.
Supported by the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition.
Conflict-of-interest statement: All authors declare that they have no conflict of interest. The data presented, the statements made and the views expressed are solely the responsibility of the authors.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Claudio Romano, MD, Unit of Pediatrics, Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University of Messina, Viale Consolare Valeria, 98125 Messina, Italy.
Telephone: + 39-90-2212918 Fax: + 39-90-2212117
Received: September 18, 2016
Peer-review started: September 19, 2016
First decision: December 19, 2016
Revised: January 1, 2017
Accepted: January 17, 2017
Article in press: January 17, 2017
Published online: February 28, 2017

There are many causes of gastrointestinal bleeding (GIB) in children, and this condition is not rare, having a reported incidence of 6.4%. Causes vary with age, but show considerable overlap; moreover, while many of the causes in the pediatric population are similar to those in adults, some lesions are unique to children. The diagnostic approach for pediatric GIB includes definition of the etiology, localization of the bleeding site and determination of the severity of bleeding; timely and accurate diagnosis is necessary to reduce morbidity and mortality. To assist medical care providers in the evaluation and management of children with GIB, the “Gastro-Ped Bleed Team” of the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition (SIGENP) carried out a systematic search on MEDLINE via PubMed ( to identify all articles published in English from January 1990 to 2016; the following key words were used to conduct the electronic search: “upper GIB” and “pediatric” [all fields]; “lower GIB” and “pediatric” [all fields]; “obscure GIB” and “pediatric” [all fields]; “GIB” and “endoscopy” [all fields]; “GIB” and “therapy” [all fields]. The identified publications included articles describing randomized controlled trials, reviews, case reports, cohort studies, case-control studies and observational studies. References from the pertinent articles were also reviewed. This paper expresses a position statement of SIGENP that can have an immediate impact on clinical practice and for which sufficient evidence is not available in literature. The experts participating in this effort were selected according to their expertise and professional qualifications.

Keywords: Gastrointestinal bleeding, Endoscopy, Lower gastrointestinal bleeding, Upper gastrointestinal bleeding, Pediatric

Core tip: This review provides a practical diagnostic guide for clinicians for the diagnosis and management of gastrointestinal bleeding (GIB) in children. Clinical presentation can be variable and bleeding can occur in any area of the gastrointestinal tract. The differential diagnosis is important to define the sequence of management. Upper endoscopy and colonoscopy are the mainstay of initial investigations. Best outcomes are possible by a multidisciplinary approach including clinicians with skills in pediatric gastroenterology, radiology and surgery. For cases of major GIB, stabilization of the patient’s condition precludes any diagnostic examination.