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Evolution of pediatric gastrointestinal ulcer disease: Is acute surgical intervention relevant?
Alyssa D Brown1, Michael D Traynor2, D Dean Potter3
1Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, 55905, USA.
Insights
Pediatric gastrointestinal ulcers are uncommon, but immunosuppressed children face higher risks. These children often require surgery and experience more complications than their immunocompetent peers.
Area of Science:
- Pediatric Gastroenterology
- Surgical Outcomes
- Immunocompromised Patients
Background:
- Contemporary data on pediatric gastrointestinal ulcer disease is scarce.
- Immunosuppression is a significant factor in pediatric ulcer disease severity.
- Hypothesis: Ulcers in immunosuppressed children are more likely to necessitate surgical intervention.
Purpose of the Study:
- To investigate the characteristics and outcomes of pediatric gastrointestinal ulcers.
- To compare surgical intervention rates and complications between immunosuppressed and immunocompetent pediatric patients.
- To highlight the need for updated data on pediatric ulcer disease.
Main Methods:
- Retrospective review of 129 pediatric patients (<21 years) diagnosed with ulcers between 1990-2019.
- Data collection included clinical findings and outcomes.
- Study design: Prognosis study with Level III evidence.
Main Results:
- 19.4% of pediatric ulcer cases involved immunosuppressed patients, often linked to post-transplant status, cancer, or post-transplant lymphoproliferative disease (PTLD).
- Immunosuppressed children required surgical intervention significantly more often (47.3%) than immunocompetent children (16.4%), including all PTLD cases.
- Surgical complications in immunosuppressed patients were frequent, including bleeding, sepsis, and 30-day mortality.
Conclusions:
- Surgical intervention for pediatric ulcers remains a critical aspect of treatment.
- Immunosuppressed pediatric patients with gastrointestinal ulcers experience higher complication rates and prolonged hospital stays.
- Prophylaxis and early investigation of epigastric pain are crucial for high-risk pediatric patients.
Background:
There is a lack of contemporary data about pediatric gastrointestinal ulcer disease. We hypothesized that ulcers found in immunosuppressed children were more likely to require surgical intervention.
Methods:
All children <21 years (n = 129) diagnosed with ulcers at a quaternary hospital from 1990 to 2019 were retrospectively reviewed. Clinical findings and pertinent information were collected.
Results:
Of 129 cases, 19 (14.7%) were immunosuppressed. Eight were post-transplant; four were diagnosed with post-transplant lymphoproliferative disease (PTLD). Eight were associated with cancer. Three were both. Three of 19 immunosuppressed and 28/110 immunocompetent patients were taking acid suppression therapy. Nine immunosuppressed patients required surgical intervention, including all PTLD cases, compared to 14 immunocompetent (47.3% vs 16.4%, p < 0.01). Five patients had duodenal perforation, two had multiple small bowel perforations, and two had uncontrolled bleeding. Of 9/19 immunosuppressed patients, surgical complications included bleeding (n = 7), sepsis (n = 2), ostomy reoperation/readmissions (n = 2), and death within 30 days (n = 2). Two/eighteen immunocompetent patients had bleeding complications.
Conclusion:
Surgical treatment for ulcers remains relevant for pediatric patients. Immunosuppressed patients have more complications, longer hospital stays, and are more likely to need surgical intervention. Efforts should be made for ulcer prophylaxis with a low threshold to investigate epigastric pain in these complex patients.
Level Of Evidence:
Prognosis Study Level III Evidence.
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