Microsoft word - cag_todo.doc
Information on the pediatric patient
No formal statement on the management of UGI bleeding in children was generated,
because of a lack of high quality evidence; however, a brief narrative summary is provided.
In infants, children, and adolescents, non-variceal UGI bleeding occurs less commonly
than in adults (1, 2). However, as with the adult patient, major UGI bleeding in the pediatric
patient is a serious medical condition requiring prompt diagnosis and therapy. The infant and
young child compensates for shock by developing tachycardia prior to becoming hypotensive.
Hypotension is a late and ominous sign of shock in children. Resuscitation efforts must be
instituted promptly because blood volume is limited and venous access can be difficult. Causes
of non-variceal UGI bleeding in neonates, infants, and toddlers are unique and special pediatric
equipment is required for diagnostic and therapeutic endoscopy (1-3). Toddlers and children up
to 12 years of age metabolize intravenous and oral PPIs at a faster rate than adults (4-8), and
optimal dosing strategies remain unstudied. Little information is available about the metabolism
of PPIs in infants under one year of age. A discussion of the specific diagnosis and management
of non-variceal UGI bleeding in infants and the young child is beyond the scope of this
consensus statement and readers are referred to recent literature (1-3, 7, 8).
In the older child or adolescent, the causes of non-variceal UGI bleeding are generally
similar to those in adult patients. However, due to the low prevalence of UGI bleeding in these
age groups, data on therapeutic endoscopy are limited to case reports. Many of the hemostatic
endoscopic techniques used in adult patients have been successfully used in children (1-3).
Adolescents metabolize intravenous and oral PPIs in a manner similar to adults (4, 5, 9). Thus, in
pediatric patients who weigh more than 40 kg (50th percentile for 12 year old males and females),
the dosing regimen for adults can be used.
There is an urgent need for additional pediatric studies to evaluate the pharmacokinetics
and acute efficacy of intravenous PPI therapy in the pediatric patient with non-variceal UGI
bleeding. Studies are also needed to compare the efficacy of various therapeutic endoscopy
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Therapeutic intervention for nonvariceal gastrointestinal hemorrhage. J Pediatr Gastroenterol Nutr
Jacqz-Aigrain E, Bellaich M, Faure C, Andre J, Rohrlich P, Baudouin V, et al.
Pharmacokinetics of intravenous omeprazole in children. Eur J Clin Pharmacol
Andersson T, Hassall E, Lundborg P, Shepherd R, Radke M, Marcon M, et al.
Pharmacokinetics of orally administered omeprazole in children. International Pediatric
Omeprazole Pharmacokinetic Group. Am J Gastroenterol
Faure C, Michaud L, Shaghaghi E, Popon M, Laurence M, Mougenot J, et al.
Lansoprazole in children: pharmacokinetics and efficacy in reflux oesophagitis. Aliment
Faure C, Michaud L, Shaghaghi E, Popon M, Turck D, Navarro J, et al.
omeprazole in children: pharmacokinetics and effect on 24-hour intragastric pH. J
Pediatr Gastroenterol Nutr
Kaufman S, Lyden E, Brown C, Davis C, Andersen D, Olsen K, et al.
therapy in pediatric patients after liver and intestinal transplantation. J Pediatr
Gunasekaran T, Pan W, Torres-Pinedo R, Book L, et al.
lansoprazole in adolescents with GERD [abstract]. J Pediat Gastroenterol Nutr
John Monterosso · George Ainslie Beyond discounting:possible experimental models of impulse controlReceived: 17 March 1999 / Final version: 6 June 1999 Abstract Animal studies of impulsivity have typically core of most if not all conceptions, though, is the notionused one of three models: a delay of reward procedure, aof irrationality. In the animal literature, this irrationalitydiffere
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