Abstract 4442

Purpose

For hemophiliacs gastrointestinal hemorrhage is a life-threatening complication and can be caused by the Helicobacter pylori infection. In this study, the prevalence of H. pylori infection among child hemophiliacs with gastrointestinal hemorrhage and the recurrence rate after eradication H. pylori treatment was investigated.

Patients and Methods

Seven children with hemophilia A with hematemesis (age, 5.3∼17.0 year) were evaluated for the causes of gastrointestinal hemorrhage and the detection of H. pylori. Gastroendoscopy was done to find the bleeding focus and for further evaluation including rapid urease test and mucosal biopsy.

Result: Four patients had dyspepsia and abdominal pain for several weeks or months prior to hematemesis. Three patients did not show any signs of bleeding. From gastroendoscopy, four patients were diagnosed as duodenal ulcer, one as H. pylori associated chronic gastritis and one as hemorrhagic gastritis. One patient showing a normal finding was diagnosed with adenoid hemorrhage after nasopharyngoscopy. H. pylori infection was found in four of six patients with GI bleeding (3, duodenal ulcer; 1, H. pylori associated chronic gastritis). The patients with H. pylori infection had an eradication treatment of triple therapy and no recurrence happened.

Conclusion

In child hemophiliacs, H. pylori should also be considered as an important cause of gastrointestinal hemorrhage. The recurrence of the infection and gastrointestinal hemorrhage can be prevented with eradication of H. pylori. Screening test for H. pylori would be needed in child hemophiliacs in endemic area.

Table 1.

The characteristics of hemophiliac children and the study results of upper gastroendoscopy, UBT, CLO and biopsy

No.Age (years)Disease severity of hemophiliaPrevious GI symptomBP (mmHg)HR (/min)Hb (g/dL)Upper gastroendoscopyUBTCLOBiopsy
P1 17.6 severe abdominal pain for 2 years 100/60 92 8.0 duodenal ulcer NA positive H. pyroti 
P2 15.1 moderate none 85/40 110 6.1 duodenal ulcer NA positive H. pyroti 
P3 10.3 moderate none 103/69 135 7.6 duodenal ulcer NA positive H. pyroti 
P4 13.8 moderate abdominal pain for 1 month 110/60 120 5.0 gastritis with nodularity positive NA NA 
P5* 5.3 moderate none 70/40 130 7.2 normal NA NA NA 
P6 11.8 mild abdominal pain for 2 weeks 120/60 107 5.9 hemorrhagic gastritis negative NA NA 
P7 12.5 moderate abdominal pain for 2 weeks 100/46 120 5.0 duldenal ulcer negative NA NA 
No.Age (years)Disease severity of hemophiliaPrevious GI symptomBP (mmHg)HR (/min)Hb (g/dL)Upper gastroendoscopyUBTCLOBiopsy
P1 17.6 severe abdominal pain for 2 years 100/60 92 8.0 duodenal ulcer NA positive H. pyroti 
P2 15.1 moderate none 85/40 110 6.1 duodenal ulcer NA positive H. pyroti 
P3 10.3 moderate none 103/69 135 7.6 duodenal ulcer NA positive H. pyroti 
P4 13.8 moderate abdominal pain for 1 month 110/60 120 5.0 gastritis with nodularity positive NA NA 
P5* 5.3 moderate none 70/40 130 7.2 normal NA NA NA 
P6 11.8 mild abdominal pain for 2 weeks 120/60 107 5.9 hemorrhagic gastritis negative NA NA 
P7 12.5 moderate abdominal pain for 2 weeks 100/46 120 5.0 duldenal ulcer negative NA NA 

BP, blood pressure; HR, heart rate; Hb, hemoglobin; UBT, 13C urea breath test; CLO, rapid urease test; NA, not analyzed

*

Adenoid bleeding

View Large
Disclosures:

No relevant conflicts of interest to declare.

Topics:
child, gastrointestinal bleeding, helicobacter infections, helicobacter pylori gastritis, abdominal pain, duodenal ulcer, hemorrhage, infections, biopsy, chronic gastritis

Author notes

*

Asterisk with author names denotes non-ASH members.

© 2009 by The American Society of Hematology
2009
Sign in via your Institution