p EPTIC ULCER DISEASE in children presents an interesting and sometimes difficult problem to the clinician. The literature, until recently, has produced only small collected series since the incidence in any one institution was quite small. Greater interest by pediatricians, surgeons, radiologists, and pathologists has increased the number of cases being reported. Since the Bird, Limper, and Mayer ~ article in 1941 which summarized the world literature and included 245 cases of peptic ulcer disease in childhood, single institutions are now seeing as many as five new cases per year. 2 There has also been a changing attitude toward this lesion. No longer is it considered a rare, medically treated disease but rather a reasonably common entity requiring an aggressive surgical approach. The cases at Children's Hospital of Pittsburgh (CHP) have been reviewed from 1953-1972 and compared in two 10-yr periods--1953-1962 and 19631972. Patients have been divided into acute and chronic peptic ulcer groups. The acute ulcer includes the spontaneous ulcer of the neonate as well as the disease or drug related ulcer which includes stress, Cushing, Curling, and steroid induced ulcers. The chronic ulcer resembles that of the adult with a history of chronic and recurrent abdominal discomfort associated with a radiologically deformed duodenum or a frank ulcer crater. With both categories of ulcer, the only patients included were those whose diagnosis was unequivocal by x-ray, laparotomy, autopsy, or clinical evaluation where the signs and symptoms could not be confused with any other disease. Approximately 200 charts were reviewed with the record room diagnosis of peptic ulcer, but only 116 met the rigid criteria and were included in this study.