778 Treatment of Gastric Outlet Obstruction Due to Peptic Ulcer in Four Children

Abstract

Background: Peptic ulcer disease complicated with gastric outlet obstruction (GOO) is rare in children. The experience in management of such patients is limited. The purpose of this study is to review the etiology, clinical manifestations, treatment and outcome of the patients in two tertiary referral centers. Material and methods: From 2005 to 2008, all the pediatric patients admitted to National Cheng Kung University Hospital and Kaohsiung Veterans General Hospital, Taiwan due to pyloric stenosis were reviewed. Infantile hypertrophic pyloric stenosis (IHPS) and anatomical anomalies, such as atresia, web were excluded. Four patients were enrolled into the study. The diagnosis of all the patients were confirmed by panendoscopy and barium meal study in all the patients. Results: There were 3 boys and one girl. The mean age was 32 months (15-71 months). Two patients had ulcer over the pre-pyloric area and the other two had duodenal ulcer. The etiology of peptic ulcers included non-steroid anti-inflammation drugs (NASIDs) ingestion (2), Helicobacter pylori and unknown (1). All patients manifested as post-prandial vomiting. Three patients received conservative treatment including proton pumping inhibitor succeβfully. Only one patient received operation with Billroth I +vagotomy due to pyloric complete obstruction. No recurrent gastric outlet obstruction was noted in all the patients Conclusions: NSAIDs ingestion was an important cause of peptic ulcer in children. Conservative treatment including PPI should be first line therapy for the gastric outlet obstruction due to peptic ulcer in children. Surgical treatment should be reserved for the patients with failed medical treatment.