Upper gastrointestinal tract bleeding in critically ill pediatric patients

Similar to adults, children under physiologic stress can develop an imbalan ce in defensive (mucosal layer, motility) and aggressive (gastric acid, bil e salts, enzymes) factors responsible for maintaining a healthy gastrointes tinal tract. Hypoxia in the gastrointestinal tract likely disrupts the defe nsive factors, thereby permitting damage by aggressive factors to upper gas trointestinal epithelium that may progress to stress ulceration and acute u pper gastrointestinal tract bleeding (UGIB). The basic pathophysiology may be similar in children and adults; however, differences in the time to deve loping ulceration, ulcer location, and number of ulcers have been reported. Functional development of the gastrointestinal tract is influenced by dise ase, gestational and postnatal age, and exposure to and type of enteral fee dings, thereby confounding the development and prophylaxis of UGIB in neona tes and infants. In addition, pharmacotherapy decisions are often complicat ed by drug administration issues and adverse effects.