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Long-term follow-up of childhood duodenal ulcers
1Department of Surgery, The University of Hong Kong, Queen Mary Hospital.
Insights
Childhood duodenal ulcers resistant to H2-receptor antagonist (H2RA) treatment often require Helicobacter pylori eradication or surgery for long-term healing. Unprovoked ulcers in children lead to significant morbidity, necessitating ongoing monitoring.
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Surgery
- Clinical Pharmacology
Background:
- Childhood duodenal ulcers present diagnostic and therapeutic challenges.
- Long-term outcomes of pediatric duodenal ulcers treated with H2-receptor antagonists (H2RA) require further investigation.
Purpose of the Study:
- To report the long-term results of duodenal ulcers in children treated with H2-receptor antagonists (H2RA).
- To evaluate the efficacy of H2RA in managing various presentations of childhood duodenal ulcers.
Main Methods:
- Retrospective review of 32 children with endoscopically proven duodenal ulcers (1975-1988).
- Evaluation of long-term outcomes after initial H2RA treatment, with updated follow-up and patient recall.
- Analysis of ulcer etiology (NSAID-induced vs. unprovoked) and treatment response.
Main Results:
- NSAID-induced ulcers responded well to H2RA therapy.
- Unprovoked ulcers showed resistance to H2RA alone, requiring H. pylori eradication or surgery.
- Proximal gastric vagotomy (PGV) showed fewer complications than truncal vagotomy and pyloroplasty (VP).
Conclusions:
- Unprovoked childhood duodenal ulcers are associated with significant long-term morbidity.
- Most childhood duodenal ulcers are resistant to H2RA monotherapy, necessitating H. pylori eradication or surgical intervention.
- PGV may be a sufficient surgical option for duodenal ulcers without obstruction.
Purpose:
This study reports the long-term results in children who have duodenal ulcers diagnosed by endoscopy who were treated with H2-receptor antagonist.
Methods:
The medical records of 32 children admitted into The Queen Mary Hospital with endoscopically proven duodenal ulcers between 1975 and 1988 were reviewed to evaluate the long-term outcome of childhood duodenal ulcers after initial treatment with H2-receptor antagonist (H2RA). Follow-up details were updated and patients who had been lost to follow-up were recalled. The age of the 22 boys and 10 girls at the time of diagnosis of the ulcers ranged from 3 to 16 years (mean, 11.8 yrs). The duration of follow-up ranged from 8.5 to 21 years (mean, 11.6 yrs).
Results:
Their primary presentations included epigastric pain (n = 9, 28.0%); nonsteroidal antiinflammatory drug (NSAID)-induced gastrointestinal bleeding (GIB, n = 6, 18.7%); unprovoked GIB (n = 12, 37.5%); perforation (n = 4, 12.5%); and pyloric obstruction (n = 1, 3.0%). All 13 patients who had NSAID-induced ulcers (pain and bleeding) responded to H2RA therapy and required no further treatment. All 14 patients who had unprovoked ulcers who presented with pain or bleeding did not respond to H2RA treatment. Ulcer healing was achieved only after eradication of Helicobacter pylori with antibiotics (n = 8) or definitive surgery involving either truncal vagotomy and pyloroplasty (VP, n = 4) or proximal gastric vagotomy (PGV, n = 2). The patient who had gastric outlet obstruction had vagotomy and antrectomy. All four patients who had perforation were initially treated with patch repair, but two had persistent ulceration despite H2RA treatment and required PGV. Complications developed in none of the four patients who had PGV, whereas two of the four patients with VP had problems (diarrhea, n = 1; bezoar obstruction, n = 1).
Conclusions:
Unprovoked childhood duodenal ulcer is associated with significant long-term morbidity and requires continued follow-up. The majority of the ulcers are resistant to H2RA treatment alone and ultimately require either eradication of H. pylori or surgery. In the absence of obstruction, PGV may be enough to resolve the ulcer diathesis.