Pediatr Gastroenterol Hepatol Nutr.  2015 Mar;18(1):30-38. 10.5223/pghn.2015.18.1.30.

Availability of Blood Urea Nitrogen/Creatinine Ratio in Gastrointestinal Bleeding with Melena in Children

• Kim KS
• Kang CH
• Kim JY

• KMID: 2315533
• DOI: http://doi.org/10.5223/pghn.2015.18.1.30

Abstract

PURPOSE
The aims of our study were to evaluate the blood urea nitrogen to creatinine ratio (BUN/Cr ratio) for distinguishing between an upper and lower gastrointestinal bleeding (GIB), and differentiating between the two most common causes of upper gastrointestinal bleeding (UGIB) presenting with melena in children.
METHODS
Retrospective data of patients with GIB presenting with melena were analyzed. The data from 60 cases were reviewed including demographics, laboratory findings, diagnostic modalities and results, treatments, and transfusions.
RESULTS
Among the 60 cases, UGIB and lower gastrointestinal bleeding (LGIB) were found in 35 cases (58.3%) and 14 cases (23.3%), respectively. The two common causes of UGIB were varices (37.1%), and peptic ulcer diseases (PUD) (31.4%). The BUN/Cr ratio of 30 or greater was higher in UGIB than LGIB (odds ratio [OR], 6.9; 95% confidence interval [95% CI], 1.3-37.2). In UGIB, the BUN/Cr ratio of the varices group was higher than that of the PUD group (p=0.015). The OR for the BUN/Cr ratio appeared as 1.2 per unit increase in the varices group than the PUD group (95% CI, 1.03-1.3). There was no difference between the PUD group and Meckel's diverticulum group.
CONCLUSION
The BUN/Cr ratio was not uneven in differentiating UGIB from LGIB of children with melena in our study. This suggests that BUN/Cr ratio should be interpreted carefully.

Keyword

Gastrointestinal; Bleeding; Melena; Child

MeSH Terms

Blood Urea Nitrogen
Child*
Creatinine
Demography
Hemorrhage*
Humans
Meckel Diverticulum
Melena*
Peptic Ulcer
Retrospective Studies
Urea*
Varicose Veins
Creatinine
Urea

Figure

• 

  Fig. 1 Age distribution of enrolled patients. UGIB: upper gastrointestinal bleeding, LGIB: lower gastrointestinal bleeding.

• 

  Fig. 2 Etiologies of patients with melena due to gastrointestinal bleeding. Type I: passage of tarry black stool only, type II: passage of tarry black stool mixed with or preexisting fresh blood, unclassified: cannot classify stool whether type I or II, UGIB: upper gastrointestinal bleeding, AV: arteriovenous, GIST: gastrointestinal stromal tumor, LGIB: lower gastrointestinal bleeding.

• 

  Fig. 3 Blood urea nitrogen to creatinine ratio (BUN/Cr ratio) of the three common causes presented with melena. 1.2 per 1 unit increase of odds ratio (95% confidence interval, 1.03-1.3) in varix vs. peptic ulcer disease.

Reference

1. Friedlander J, Mamula P. Gastrointestinal hemorrhage. In : Wyllie R, Hyams JS, Kay M, editors. Pediatric gastrointestinal and liver disease. 3rd ed. Philadelphia: Saunders Elsevier;2011. p. 146–153.

2. Boyle JT. Gastrointestinal bleeding in infants and children. Pediatr Rev. 2008; 29:39–52.

3. Hanna E. Gastrointestinal bleeding. In : Bishop WP, editor. Gastroenterology. New York: McGraw-Hill Medical;2010. p. 65–79.

4. Carvalho ED, Nita MH, Paiva LM, Silva AA. Gastrointestinal bleeding. J Pediatr (Rio J). 2000; 76:Suppl 1. S135–S146.

5. Gilger MA. Gastrointestinal bleeding. In : Walker WA, Goulet O, Kleimann R, Sherman PM, Schneider BL, Sanderson IR, editors. Pediatric gastrointestinal disease. 4th ed. Hamilton, ON; Lewiston, NY: BC Decker;2004. p. 258–280.

6. Khamaysi I, Gralnek IM. Acute upper gastrointestinal bleeding (UGIB) - initial evaluation and management. Best Pract Res Clin Gastroenterol. 2013; 27:633–638.

7. Sittichanbuncha Y, Senasu S, Thongkrau T, Keeratikasikorn C, Sawanyawisuth K. How to differentiate sites of gastrointestinal bleeding in patients with hematochezia by using clinical factors? Gastroenterol Res Pract. 2013; 2013:265076.

8. Richards RJ, Donica MB, Grayer D. Can the blood urea nitrogen/creatinine ratio distinguish upper from lower gastrointestinal bleeding? J Clin Gastroenterol. 1990; 12:500–504.

9. Ernst AA, Haynes ML, Nick TG, Weiss SJ. Usefulness of the blood urea nitrogen/creatinine ratio in gastrointestinal bleeding. Am J Emerg Med. 1999; 17:70–72.

10. Urashima M, Toyoda S, Nakano T, Matsuda S, Kobayashi N, Kitajima H, et al. BUN/Cr ratio as an index of gastrointestinal bleeding mass in children. J Pediatr Gastroenterol Nutr. 1992; 15:89–92.

11. Prieto Bozano G, Escribano Burgos C, Ortega Páez E, Carrasco Gandía S, Lama More R, Polanco Allue I. Value of the BUN/creatinine ratio in localizing digestive system hemorrhage in children. An Esp Pediatr. 1990; 32:222–224.

12. Witting MD, Magder L, Heins AE, Mattu A, Granja CA, Baumgarten M. ED predictors of upper gastrointestinal tract bleeding in patients without hematemesis. Am J Emerg Med. 2006; 24:280–285.

13. Felber S, Rosenthal P, Henton D. The BUN/creatinine ratio in localizing gastrointestinal bleeding in pediatric patients. J Pediatr Gastroenterol Nutr. 1988; 7:685–687.

14. Cleveland K, Ahmad N, Bishop P, Nowicki M. Upper gastrointestinal bleeding in children: an 11-year retrospective endoscopic investigation. World J Pediatr. 2012; 8:123–128.

15. Rafeey M, Shoaran M, Majidy H. Diagnostic endoscopy and clinical characteristics of gastrointestinal bleeding in children: a 10-year retrospective study. Iran Red Crescent Med J. 2013; 15:794–797.

16. Hassoon AJ, Al Maeen AA, Maltloub HY. Upper gastrointestinal bleeding in children. J Fac Med Baghdad. 2012; 54:223–227.

17. Pant C, Sankararaman S, Deshpande A, Olyaee M, Anderson MP, Sferra TJ. Gastrointestinal bleeding in hospitalized children in the United States. Curr Med Res Opin. 2014; 30:1065–1069.

18. Kalyoncu D, Urganci N, Cetinkaya F. Etiology of upper gastrointestinal bleeding in young children. Indian J Pediatr. 2009; 76:899–901.

19. Villanueva C, Colomo A, Bosch A, Concepción M, Hernandez-Gea V, Aracil C, et al. Transfusion strategies for acute upper gastrointestinal bleeding. N Engl J Med. 2013; 368:11–21.

20. Sharma P, Barajas FJ, Krishnamoorthy P, Campo LM, Blumenthal E, Spinnell M. Transfusion-free management of gastrointestinal bleeding: the experience of a bloodless institute. J Clin Gastroenterol. 2015; 49:206–211.