Gastrointestinal bleeds

• Based on many observational studies (level B evidence), a gastrointestinal bleed (GIB) in a child is not a rare event, and the severity of GIBs varies widely. (11) • Based on expert opinion (level D evidence), the first action taken when confronted with a GIB in a child is to ensure hemodynamic stability. (39) • Based on many case reports and expert opinion (level B evidence), material presumed to contain blood should be tested to ensure that blood is truly present. (Stool occult blood test for stool and gastric occult blood test for vomitus. [40]) • Based on observational studies (level D), endoscopy to identify a source of bleeding can be delayed 6 to 24 hours after presentation to allow stabilization and initial laboratory testing. (12) • Based on expert opinion and case studies (level D evidence), recent technologic advances, such as video capsule endoscopy and balloon-assisted endoscopy, have joined radiologic techniques, (41) such as tagged red blood cell scanning and arteriography, as ways to identify sources of occult GIB. • Based on clinical trials and meta-analysis (level B evidence), hemostasis can be accomplished via medication, arteriography, and various endoscopic techniques. (42)(43) Surgery is a last resort.