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Two Cases of Helicobacter pylori-Negative Gastric Outlet Obstruction in Children

Raza A Patel1, Susan S Baker, Wael N Sayej

  • 1Division of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Utah and Primary Children's Medical Center, Salt Lake City, UT 84113, USA.

Case Reports in Gastrointestinal Medicine
|May 19, 2012
PubMed

Insights

Gastric outlet obstruction (GOO) in children can occur without H. pylori infection. Surgical intervention offers definitive treatment for peptic ulcer disease-related GOO when other methods fail.

Area of Science:

  • Pediatric Surgery
  • Gastroenterology
  • H. pylori Research

Background:

  • Gastric outlet obstruction (GOO) in children is typically linked to hypertrophic pyloric stenosis.
  • Historically, peptic ulcer disease (PUD) caused by H. pylori was a significant cause of GOO before advanced medical treatments.
  • Proton pump inhibitors and H2 blockers are now standard for PUD management.

Observation:

  • Two pediatric patients presented with symptoms of weight loss, vomiting, and abdominal pain, indicative of PUD and GOO.
  • Esophagogastroduodenoscopy (EGD) and upper gastrointestinal (UGI) series confirmed PUD and GOO diagnoses.
  • Despite repeated negative H. pylori tests, both patients received H. pylori eradication therapy.

Findings:

  • GOO secondary to PUD can manifest even with negative H. pylori testing.
  • Pharmaceutical management failed for both patients, necessitating alternative treatments.
  • Patient 1 underwent surgery, while Patient 2 required six pyloric dilations followed by surgery for definitive treatment.

Implications:

  • These cases highlight that PUD can cause GOO in children irrespective of H. pylori status.
  • Surgical management, including pyloric dilation and surgery, provides effective definitive therapy for refractory GOO.
  • Further research may explore non-H. pylori related PUD mechanisms in pediatric GOO.

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