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Acute duodenal ulcer
1Department of Paediatrics, College of Medicine, National Taiwan University, Taipei, ROC.
Insights
Acute duodenal ulcers in young children often follow viral illnesses. These pediatric ulcers typically heal rapidly with medical treatment, even if multiple or irregularly shaped.
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Pathology
- Infectious Diseases
Background:
- Acute duodenal ulcers are uncommon in infants and children.
- Previous studies have not fully elucidated the etiology and clinical course in this age group.
Purpose of the Study:
- To investigate the clinical characteristics, endoscopic findings, and outcomes of acute duodenal ulcers in a pediatric population.
- To explore the potential association between preceding illnesses and the development of duodenal ulcers in children.
Main Methods:
- Retrospective study of 31 infants and children diagnosed with acute duodenal ulcers via endoscopy over eight years.
- Clinical data, including preceding illnesses and symptoms, were analyzed.
- Endoscopic findings regarding ulcer morphology, number, and location were documented.
- Follow-up endoscopy and long-term outcomes were assessed.
Main Results:
- The majority of patients (58%) were under two years old.
- Upper gastrointestinal bleeding was the most frequent symptom (87%).
- A preceding illness, such as diarrhea, respiratory infection, or fever, was reported in 94% of cases.
- Most ulcers (77%) healed completely within one to two weeks of initial diagnosis.
- Medical management was successful in 97% of patients, with only one requiring surgery for uncontrollable hemorrhage.
Conclusions:
- Young children can develop acute duodenal ulcers, often associated with viral illnesses, irrespective of antipyretic drug use.
- Pediatric acute duodenal ulcers demonstrate rapid healing and favorable long-term outcomes with appropriate medical management.
- The findings underscore the importance of considering viral-associated duodenal ulcers in the differential diagnosis of gastrointestinal bleeding in children.
Abstract:
A series of 31 infants and children with acute duodenal ulcer verified by endoscopy was studied over an eight year period. Eighteen (58%) of them were under 2 years of age. The most common symptom was upper gastrointestinal bleeding (n = 27, 87%). Twenty nine patients (94%) had a preceding illness characterised by diarrhoea, upper respiratory tract infection, or fever, which was not necessarily treated with antipyretic drugs. Initial endoscopy showed that ulcer lesions were solitary in 14 patients and present on the anterior wall (n = 11), posterior wall (n = 2), or both (n = 1). Multiple ulcers were found in 17 patients, and present in the bulb with (n = 6) or without (n = 11) extension into the second part of duodenum. The most conspicuous finding was the irregularly shaped ulcers seen in eight young children with similar clinical and endoscopic features. Sixteen patients were re-endoscoped one to two weeks after the initial examination; the ulcers had entirely disappeared in 13, and there were only small residual ulcers in three. Thirty patients were treated medically and only one (with uncontrollable haemorrhage) required operation. Most patients were symptom free two to six years after the initial diagnosis. Our results suggest that young children may develop acute duodenal ulcers after viral illnesses whether or not they are treated with drugs, mainly antipyretics. This kind of acute duodenal ulcer usually heals quickly irrespective of the morphology, site, and number of ulcers.