Non‐Helicobacter, Non‐NSAIDs Peptic Disease in Children

Abstract

To the Editor: We read with interest the article by Tam et al (1) and the editorial by Oderda et al (2) in the March 2009 issue of JPGN. We recently published an article on 1 of the largest series of peptic disease in children (3). Our article described the prevalence and characteristics of peptic ulcers and erosions (PU&E) in the Israeli population referred by pediatric gastroenterologists for an upper endoscopy. The study was retrospective during the years January 2003 to May 2006. During these years, we obtained information on 751 diagnostic upper endoscopies. PU&E was detected in 169 (22.5%) patients (ulcers 51 [6.8%], erosions 118 [15.7%]). One hundred twenty-four had gastric PU&E and 58 had duodenal PU&E. Helicobacter pylori was positive in 112 (66.3%) patients. In concordance with Tam et al's article, we found that H pylori–associated PU&E becomes more common after age 10 years, with gastric PU&E presenting much earlier than duodenal disease. Unlike Tam et al's study, the man/woman distribution was even in our study for both H pylori–positive and –negative PU&E and the presentation rarely occurred with gastrointestinal bleeding. Most of our H pylori–negative PU&E remained idiopathic and improved symptomatically with proton pump inhibitor treatment. Interestingly, 43% of patients with PU&E in our cohort were either immigrants from the former Soviet Union or of Israeli-Arab origin. There is no doubt that the H pylori–negative PU&E is increasing in children. We believe that H pylori–negative PU&E may not be the same worldwide, may have different etiologies, and definitely should be investigated further.