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Peptic ulcer disease in children: etiology, clinical findings, and clinical course
B Drumm1, J M Rhoads, D A Stringer
1Department of Pediatrics, Hospital Sick Children, Toronto, Ontario, Canada.
Insights
Peptic ulcer disease in children is often secondary to severe illness, especially in those under 10. Primary peptic ulcers in children frequently recur, necessitating surgery in some cases.
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Surgery
Background:
- Peptic ulcer disease (PUD) is less common in children than adults.
- Etiology and clinical presentation of PUD in pediatric populations require further investigation.
Purpose of the Study:
- To evaluate the etiology, clinical course, and outcomes of pediatric peptic ulcer disease.
- To differentiate between primary and secondary PUD in children.
Main Methods:
- Retrospective review of pediatric PUD cases (excluding neonates) over a 5-year period.
- Inclusion criteria: confirmed ulcer crater via endoscopy or surgery.
- Patients categorized into primary and secondary PUD groups.
Main Results:
- 36 pediatric patients (20 boys, 16 girls) with PUD identified.
- Duodenal ulcers more common than gastric ulcers (2.8:1).
- All ulcers in children <10 years were secondary, often linked to severe illness and complications like perforation/hemorrhage.
- Primary PUD cases presented with abdominal pain, high recurrence rates (67%), and 40% required surgery for intractable disease.
- Single-contrast barium meals showed low diagnostic reliability for PUD.
Conclusions:
- Secondary PUD in children is associated with severe illness and acute complications.
- Primary PUD in children, particularly duodenal ulcers, has a significant risk of recurrence and may require surgical intervention.
- Diagnostic imaging modalities like single-contrast barium meals are unreliable for PUD in children.
Abstract:
The records of all children with peptic ulcer disease at the Hospital for Sick Children were retrospectively evaluated, excluding neonates, throughout a 5-year period. Only cases with a definite ulcer crater identified either at endoscopy or at surgery were included. There were 36 patients, 20 boys and 16 girls. Duodenal ulcers were more common than gastric ulcers (2.8:1). Ages ranged from 3 months to 17 years, with a mean age of 10 years. Patients were reviewed with respect to etiology of peptic ulcer disease, age when first examined, initial symptoms, and clinical course. Patients were divided into two groups, those with primary (n = 19) and those with secondary (n = 17) peptic ulcer disease. All peptic ulcers in patients younger than 10 years of age were secondary in nature. Secondary ulcers occurred generally in association with a severe underlying illness (11/17), and many ulcers necessitated emergency surgery because of perforation and/or severe hemorrhage (8/17). None of these patients had chronic or recurrent symptoms. In contrast, in children with primary peptic ulcer disease, initial symptoms were more benign. Most patients had abdominal pain and only one required emergency surgery. Children with primary duodenal ulcer disease had a high incidence of recurrent symptoms (67%), however, with surgery for intractable disease necessitated in 40%. Single-contrast barium meals were found to be unreliable in establishing a diagnosis of peptic ulcer disease, particularly cases of gastric ulcer disease.