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Is peptic ulcer a common cause of upper gastrointestinal symptoms?
E Roma1, Y Kafritsa, J Panayiotou
1Department of Paediatric Gastroenterology and Nutrition, Athens University, Aghia Sophia Children's Hospital, Goudi, Greece. roma2el@otenet.gr
Insights
Peptic ulcer disease in children is uncommon and presents with non-specific symptoms. Successful treatment and Helicobacter pylori eradication lead to long-term healing and clinical improvement.
Area of Science:
- Pediatric Gastroenterology
- H. pylori Infections
- Peptic Ulcer Disease
Background:
- Peptic ulcer disease (PUD) is a rare condition in children.
- Diagnosis and management of PUD have evolved.
- Clinical features are often non-specific.
Purpose of the Study:
- To retrospectively investigate a cohort of children with peptic ulcer disease.
- To analyze recent changes in PUD diagnosis and management in pediatric patients.
- To evaluate outcomes of PUD treatment and Helicobacter pylori eradication.
Main Methods:
- Retrospective cohort study of 2550 children undergoing upper gastrointestinal endoscopy over 9 years.
- Inclusion criteria: diagnosis of primary peptic ulcer.
- Evaluation of medical history, family history, endoscopic and histological findings, and long-term follow-up.
Main Results:
- 52 children (2%) were diagnosed with primary peptic ulcer (10 gastric, 42 duodenal).
- Higher prevalence of Helicobacter pylori in duodenal ulcers (62%) vs. gastric ulcers (20%).
- 95% ulcer healing rate at 1 month post-treatment, with 27% H. pylori eradication failure; 6 children symptomatic during long-term follow-up.
Conclusions:
- Peptic ulcer disease is uncommon in childhood with non-specific clinical features.
- Effective treatment and successful H. pylori eradication are crucial for clinical improvement and long-term ulcer healing.
- H. pylori eradication is key to managing pediatric peptic ulcer disease effectively.
Unlabelled:
The aim of the study was to investigate retrospectively a cohort of children with peptic ulcer disease during a period that covers the recent changes in diagnosis and management of the disease. Over a period of 9 years, 2550 children underwent upper gastrointestinal endoscopy for various reasons. All children, in whom a diagnosis of primary peptic ulcer was established, were included in the study. Previous and current medical history, family history, endoscopic and histological outcome were evaluated and the children were regularly followed-up on an out-patient basis. Primary peptic ulcer was diagnosed in 52 (10 gastric and 42 duodenal, 2%) out of 2550 children. The median age of children with gastric ulcer was 6.5 years, whereas of those with duodenal ulcer was 10.5 years (P=0.04). With regard to clinical symptoms no significant difference was found between children with and without ulcer. The prevalence of Helicobacter pylori infection was significantly higher in children with duodenal ulcer (62%) compared to those with gastric ulcer (20%; P < 0.001). At first follow-up visit, 1 month after the end of treatment, 19 symptomatic children underwent a repeat endoscopy, which showed ulcer healing in 95% and failure in H. pylori eradication in 27%. During the long-term follow-up (median 3.5 years), six children became symptomatic. Two of them had duodenal ulcer associated with positive H. pylori.
Conclusion:
Peptic ulcer disease is an uncommon disorder in childhood with non specific clinical features; it seems that efficient treatment and successful Helicobacter pylori eradication result in clinical improvement and cure as well as in long-term healing of ulcers.