ABSTRACT
Upper gastrointestinal bleeding may be the initial presentation of oesophageal varices. Variceal bleeding caused by portal hypertension should be considered in any child who has hepatomegaly, splenomegaly, ascites, jaundice or scleral icterus. For a patient with no known underlying liver disease, variceal bleeding is suggested by a past history of jaundice, hepatitis, blood transfusion, chronic right heart failure or disorders associated with extrahepatic portal vein thrombosis. Combined use of wireless capsule endoscopy and double-balloon enteroscopy is effective in the diagnosis and management of patients with obscure gastrointestinal bleeding. Bleeding is usually painless and results from ulceration within ectopic gastric tissue. Colonoscopy localises most causes of bleeding such as ulcerative colitis and helps diagnose polyps, Peutz–Jeghers's syndrome and arteriovenous malformations of the large bowel. Medical therapy for prevention of rebleeding includes non-selective beta blockers to reduce splanchnic and portal blood flow, leading to reduced portal pressure.
