Abstract

Duodenal ulcers have been reported in children with increasing frequency (5–11) since Alexander (1) published his group of thirty cases in this journal in 1951, but few of these reports have appeared in the radiologic literature (2). In the same year Morgan (10) also published an excellent review, which thoroughly discussed this condition in children. Many of the more recent papers (3, 6, 12) have stressed the psychiatric factors in the background of these young patients and we have recognized in most of our cases a typical psychologic pattern or have discovered a strong stress situation as a precipitating factor in the production of ulcer. Since 1949 we have made the diagnosis of duodenal ulcer 15 times in children between two and fifteen years old, out of approximately 92 patients of this age group seen in our office for gastrointestinal studies. This high incidence of positive findings reflects, we feel, not so much a high incidence of disease in this age group as a very conservative attitude on the part of the physicians who refer patients to us for examination. The children must complain for a long time before they are sent for study, and we feel, therefore, that we are dealing with a selected group in which a high percentage of positive examinations may be expected. The etiology of duodenal ulcer in children, as in adults, is unknown. According to Alexander, “the factors of nervousness, worry, and strain and overindulgence in food, alcohol, or tobacco would seem to play little, if any, part in the production of ulcer in patients of this age.” The implication that children have no worries is at variance with our experience, although many of the things that trouble a child would, to an adult, be inconsequential. A good example of this type of worry and nervous strain is afforded by a four-year-old boy whom we saw in 1951. He had always been well until his parents went to Europe for three months, leaving him and his brother with an aunt. The boy stopped eating, started complaining of severe abdominal pain, and on our examination was found to have a large crater in the duodenal cap. This was treated medically, and after his parents' return his symptoms subsided completely. We saw this child in 1958, after seven years, and he had had no further stomach trouble. Morgan, after reviewing the various theories of the etiology of ulcer, held the neurogenic theory to be the most tenable. In infants with brain damage, disturbances of the autonomic nervous system controlling centers may cause vascular change in the stomach or duodenum sufficiently great to allow erosive lesions to form. In older children with a suppressed anxiety state continued over a period of time, similar vascular changes may be mediated through the autonomic nervous system, leaving the mucosa of the stomach and duodenum open to ulceration.

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