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Peptic ulcer disease in early infancy: clinical presentation and roentgenographic features
Insights
Peptic ulcer disease in newborns is rare, often presenting as recurrent vomiting rather than bleeding. Most infant cases were successfully treated with conservative medical management.
Area of Science:
- Pediatric Gastroenterology
- Neonatal Intensive Care
Background:
- Peptic ulcer disease (PUD) is uncommon in neonates.
- Typical PUD presentation in infants includes gastrointestinal bleeding or perforation.
Purpose of the Study:
- To describe the clinical presentation, diagnosis, and management of peptic ulcer disease in infants.
- To highlight recurrent emesis as a common, yet under-recognized, symptom of PUD in neonates.
Main Methods:
- Retrospective chart review of 16 infants diagnosed with PUD over eight years.
- Diagnostic methods included contrast radiography, surgery, and endoscopy.
- Medical management involved orogastric suction, antacids, and milk feedings.
Main Results:
- Sixteen infants under 11 weeks old were diagnosed with PUD.
- Recurrent emesis was the primary symptom in 56% of cases, unlike typical presentations.
- Contrast radiography identified ulcers in 13 patients; most were managed medically with no deaths.
Conclusions:
- Recurrent emesis is a significant indicator of PUD in neonates.
- Early diagnosis and medical management are effective for PUD in this age group.
- PUD in neonates can be managed non-surgically, with favorable outcomes.
Abstract:
Sixteen infants under 11 weeks of age developed documented peptic ulcer disease involving the stomach, duodenum or pylorus during an eight-year period in a Newborn Intensive Care Unit. The precipitous onset of gastrointestinal bleeding and/or perforation commonly associated with ulcer disease in early infancy was present in only seven (44%) of the 16 patients. The remaining nine infants (56%) presented with recurrent emesis, a presentation of peptic ulcer disease rarely described in the first weeks of life. Contrast radiography was used to demonstrate a definite ulcer crate in 13 of these patients. Two had their ulcers diagnosed at surgery and one by endoscopy. Radiographic demonstration of pylorospasm and/or gastric retention was often associated with ulcer craters located in the pyloric channel or gastric antrum. Only two patients required surgery for massive bleeding and perforation. The remainder were successfully managed medically using orogastric suction antacids and gradual resumption of milk feedings. There were no deaths within our population attributable to peptic ulcer disease.