Peptic ulcer disease: Insights and risk factors

Peptic ulcer disease (PUD), affects adults and children, with Helicobacter pylori (H. pylori) infection being the most frequent cause. Diagnosis requires an upper gastrointestinal endoscopy (UGE) and invasive tests. However, besides H. pylori, risk factors for PUD in children remain unclear. The aim of this study is to investigate pediatric PUD's epidemiology, etiology, and associated risk factors.

A retrospective case-control study included children aged 1 month to 17 years presenting PUD, defined as presence of ulceration/erosion of the gastric/duodenal mucosa, and two controls per case. UGE's were performed between 2016 and 2022 in a pediatric center. Diagnosis of H. pylori was based on culture and histology of gastric biopsies.

Among 2355 eligible children, 335 with PUD (14.2%) and 670 controls were included. The median age was 9.9 years (IQR: 6.1-13.1). The main indications for endoscopy were dyspepsia (38.7%) and chronic abdominal pain (15.5%). H. pylori infection was more frequent in cases than controls (35.7% vs. 17.2%, p < 0.001). Independent risk factors for PUD included age ≥ 11 years (OR 1.83, 95% CI: 1.21-2.75; p = 0.004), gastrointestinal bleeding (OR 3.18, 95% CI: 1.15-8.82; p = 0.026), and concomitant medication use (OR 6.93, 95% CI: 3.51-13.7; p < 0.001). Epigastric tenderness, systemic diseases, and a family history of PUD or H. pylori infection were associated with PUD only in univariable analysis.

Older age, concomitant medications, and H. pylori infection are risk factors for pediatric PUD. In a tertiary center, PUD remains a frequent and clinically relevant diagnosis among children undergoing UGE.