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Peptic ulcer in children: the predominance of gastric ulcers
Insights
Pediatric ulcer disease, primarily antral, showed varying recurrence rates. Antral ulcers healed well with antacids or cimetidine, while duodenal ulcers recurred after cimetidine treatment.
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Diseases
- Clinical Medicine
Background:
- Ulcer disease in children is less common than in adults.
- Understanding the characteristics and outcomes of pediatric ulcers is crucial for effective management.
Purpose of the Study:
- To analyze the clinical presentation, diagnostic methods, and treatment outcomes of ulcer disease in children.
- To compare the efficacy of cimetidine and antacids in treating pediatric ulcers.
Main Methods:
- Retrospective review of 32 children with ulcer disease over four years.
- Diagnosis confirmed by endoscopy and radiography.
- Prospective treatment with cimetidine or antacids, with healing assessed by repeat endoscopy.
Main Results:
- Antral ulcers were most common (17:11 gastric to duodenal ratio).
- Endoscopy achieved 97% diagnostic accuracy; radiography was less accurate for gastric ulcers (50%).
- Primary duodenal ulcers had higher recurrence (45%) than primary gastric ulcers (12%); secondary ulcers did not recur.
Conclusions:
- Isolated antral ulcers in children show good clinical outcomes with either cimetidine or antacids.
- Cimetidine may be initially effective for duodenal ulcers but recurrence is common after treatment cessation.
- Cimetidine offers no apparent advantage over antacids for uncomplicated pediatric antral ulcers.
Abstract:
Thirty-two children with ulcer disease were seen over a four-year period. Twenty-seven children had a primary ulcer and five had an ulcer associated with an acute or chronic illness (secondary ulcer). Antral ulcer was diagnosed most commonly, followed by duodenal ulcer and gastric body ulcer. The ratio of gastric ulcer to duodenal ulcer was 17:11. Diagnosis of ulcer was accomplished by endoscopy in 97% of the patients and by radiography in 70% of those studied. Radiologic accuracy was obtained in 89% with duodenal ulcer but in only 50% of those with gastric ulcer. Children with primary gastric ulcer presented with no evidence of chronicity and 12% had persistence or recurrence of ulcer during follow-up. Eighty-two percent of the children with primary duodenal ulcer presented with chronic symptoms consisting of abdominal pain, nausea, vomiting or recurrent bleeding and 45% had persistence or recurrence of ulcer during follow-up. Children with secondary ulcer all presented with acute symptoms and none had persistence or recurrence. Twenty children were treated prospectively with cimetidine and 11 were treated with antacids. Repeat endoscopy was employed in 16 as a measure of healing. All children with isolated antral ulcer did well clinically, regardless of mode of therapy and of those studied by re-endoscopy all showed complete or substantial healing at six to eight weeks. Treatment of a small group of children with primary duodenal ulcer using cimetidine was initially efficacious, although recurrence of ulcer was noted after cessation of treatment in four of six children given cimetidine. In addition, cimetidine appears to offer no advantage compared to antacids in the treatment of uncomplicated antral ulcer in children.