Primary prophylaxis of variceal upper gastrointestinal bleeding in children and adolescents with portal hypertension: an integrative review

Portal hypertension is characterized by increased blood pressure in the portal vein and its branches. Recent studies indicate that upper gastrointestinal bleeding in children is associated with significant morbidity, although mortality rates are lower than in adults. Prophylactic strategies are implemented in some pediatric centers, but there is no consensus on the optimal management for this population. The aim of this study was to conduct an integrative review on the primary prophylaxis of variceal UGIB in the pediatric population with portal hypertension, whether cirrhotic or not, through the use of beta-blockers and endoscopic procedures such as elastic band ligation and sclerotherapy. A integrative review of the scientific literature was conducted on the PubMed/Medline databases. A total of 153 articles were identified, and 26 were selected for integrative review after a thorough examination, comprising 2 meta-analyses, 3 randomized clinical trials, and 21 uncontrolled observational studies. The integrative review highlight the challenges and limitations associated with the use of non-selective beta-blockers in children, revealing a considerable frequency of side effects leading to drug discontinuation. Comparative studies indicate a higher risk of bleeding in the group using propranolol compared to primary endoscopic prophylaxis, despite methodological limitations. As for the evaluated studies on primary endoscopic prophylaxis, they suggest few complications and demonstrate efficacy in variceal eradication, although a high risk of recurrence persists.