https://www.ncbi.nlm.nih.gov/pubmed/29851765

Acute variceal bleeding
J Pediatr Gastroenterol Nutr. 2018 May 30. doi: 10.1097/MPG.0000000000002039. [Epub ahead of print]"Acute Variceal Bleeding Causes Significant Morbidity".Moura MC1, Chen S2, Kamath BM3, Ng VL1, Ling SC1.

Abstract

BACKGROUND AND AIMS:
The need for primary prophylaxis of variceal bleeding in children is unclear due to insufficient evidence of the efficacy of prophylactic therapy and the mortality and morbidity associated with the first bleeding event. Previous studies have provided estimates of mortality. We aimed to investigate the morbidity associated with acute variceal bleeding (AVB) in children and to identify contributing factors.

METHODS:
We retrospectively reviewed children with chronic liver disease or portal vein thrombosis admitted with acute upper gastrointestinal bleeding between 2000 and 2015.

RESULTS:
Seventy AVB episodes in 57 children (median age 6 y, 52% female) were included, 58% with cirrhosis and 30% portal vein thrombosis. 67% were the patient's first bleed. Post-AVB morbidity was present in 57% of all episodes and in 64% of first bleeds and included: ascites (34%), infection (30%), respiratory complications (24%), ICU admission (20%), re-bleed (11%), encephalopathy (7%), acute kidney injury (6%) and failure to control bleed (4%). Two patients died (4% of first bleeds, 8% of cirrhotics' first bleeds) within 6 weeks of bleeding. Median length of stay was 7 days. Overall morbidity was associated with total bilirubin (p = 0.001). Ascites after AVB was associated with PELD (p = 0.0007), total bilirubin (p = 0.001) and cirrhosis (p = 0.006). Median length of stay was longer in patients with morbidities (18 vs 4 days, p < 0.0001).

CONCLUSION:
Children with AVB suffer significant morbidity but have a low risk of death. Morbidity should therefore be considered in future studies measuring the risks and benefits of primary prophylaxis of first AVB in children.