Peptic Ulcer Disease In Children Research Articles

Peptic ulcer disease in children

Peptic ulcer disease is uncommon in children. Ulcers may be primary or secondary in nature. When primary ulcers occur, they are usually duodenal. The vast majority of primary duodenal ulcers are associated with Helicobacter pylori infection of the gastric antral mucosa. Although H. pylori is almost always acquired in childhood, peptic ulceration is rare under the age of 10 years. The host or bacterial factors which result in a minority of H. pylori infected individuals developing duodenal ulcer disease are as yet unknown. Secondary ulceration which may be gastric or duodenal can occur at any age. It may be life threatening in the acute phase due to the risk of perforation, but after healing, recovery is usually complete.

Peptic ulcer disease in children without Helicobacter pylori infection.

Peptic ulcer disease in children without Helicobacter pylori infection.

Recurrent abdominal pain.

1. Paul N. Thiessen, MD* 1. *Editorial Board. Clinical Professor of Pediatrics, B.C. Children’s Hospital, Vancouver, B.C., Canada After completing this article, readers should be able to: 1. Characterize the epidemiology and classification of recurrent abdominal pain. 2. List the major clinical conditions that manifest with recurrent abdominal pain. 3. Describe the most important findings in the history and physical examination of the child who has recurrent abdominal pain that suggest an organic medical condition. 4. Outline a targeted approach to ordering investigations that will confirm or disprove suspected organic disease. 5. Delineate the prognosis of recurrent abdominal pain. Recurrent abdominal pain (RAP) is a frequent and troublesome complaint in childhood and adolescence, and the search for a cause and a credible approach to management can be taxing for both family and physician. The term “recurrent abdominal pain” was coined by the British pediatrician John Apley, who first published on the subject in 1958. His definition included at least three attacks of pain occurring over a period of 3 months that were severe enough to affect activities and for which no organic cause was identified. In practice, the definition may include any child or adolescent who has RAP for which the family seeks medical attention and explanation, even if the duration of the pain does not adhere strictly to the Apley definition. The definition explicitly excludes the many causes of acute abdominal pain, which lie outside the scope of this review. There is wide variation in the threshold of severity and frequency that must be crossed before a family will seek medical attention for a child who has RAP. Inevitably, parents want a clear explanation and reassurance that no sinister causes lurk undetected, and the clinician wants to oblige but often lacks the conviction that organic causes have been excluded. The most difficult challenge for the clinician is to determine to what extent diagnostic studies should be employed before the label “recurrent abdominal …

A review of omeprazole use in the treatment of acid-related disorders in children

Background: Acid peptic disease is a common problem, with a similar prevalence of gastroesophageal reflux disease (GERD) in adults and children. The presentation of GERD in infants and children varies from crying, irritability, or sleep disturbance to feeding difficulties, vomiting, or rumination. Helicobacter pylori (HP)—related diseases and gastric and duodenal ulcers are much more common in adults than in children, who are more likely to have gastritis or duodenitis. However, because HP infection is most likely acquired in childhood, treatment of children with endoscopically documented active HP disease may minimize the potential risk for peptic ulcer or gastric cancer in adulthood, although this is yet to be proved. Objective: Omeprazole has been shown to be effective in the treatment of acid-related diseases. This paper reviews the literature on the use and administration of omeprazole for the treatment of GERD, peptic ulcer disease, HP infection, and other acid-related conditions in children. Methods: Studies were identified through searches of MEDLINE ® and Science Citation Index for the period 1986 to November 2000, and from the reference lists of identified articles. The search terms used included omeprazole, proton pump inhibitor (PPI), children, pediatrics, routes of administration, GERD, HP infection, esophagitis, and administration. In addition, the manufacturer of omeprazole was asked for relevant unpublished information. Results: Marketed and extemporaneous formulations of omeprazole have been administered to children aged 2 months to 18 years for the treatment of erosive esophagitis, gastric ulcer, duodenal ulcer, HP infection, and related conditions at dosages of 5 to 80 mg/d (0.2–3.5 mg/kg/d) for periods ranging from 14 days to 36 months with a low incidence of adverse effects. The initial dose most consistently reported to heal esophagitis and provide relief of symptoms of GERD appears to be 1 mg/kg per day. Conclusions: In uncontrolled clinical trials and case reports to date, omeprazole has been effective and well tolerated for the acute and chronic treatment of esophageal and peptic ulcer disease in children, particularly those who had failed to respond to previous treatment with histamine 2-receptor antagonists. Should future long-term, controlled clinical trials in children demonstrate safety and efficacy, this PPI is likely to find a place in the armamentarium of pediatric pharmacotherapy.

Peptic ulcer

OBJECTIVE: To present a current review about pathogenesis, pathophysiology, diagnosis, and treatment of peptic ulcer disease in children, based on the reviewed publications and the author personal experience. METHODS: We revised the most relevant articles about peptic ulcer in children, published from the last 20 years. RESULTS: The gastroduodenal peptic ulcer is very common in adults, mostly in the developing countries. Although it is less frequent in children, the optical fibroendoscopy has improved the number of diagnosed cases. The peptic ulcer is classified as its etiology in primary and secondary. The secondary peptic ulcer is related to a subjacent disease or use of drugs, while the primary ulcer happens in the absence of underlying systemic diseases The primary duodenal ulcer is the most common presentation, and there are strong evidences of the H. pylori association in the etiology. Clinical presentation changes with age and ulcer type. Secondary ulcers are mostly acute and sometimes dramatic, while the primary ones have a chronic evolution mostly similar to patients with functional recurrent abdominal pain, but the presence of epigastric pain, feeding-related pain, vomiting, bleeding, familiar history for peptic ulcer, nocturnal pain, and male gender are strongly related to peptic ulcer. The acid antisecretory agents have great efficacy on relieving symptoms and solving ulcerate lesion, although the H. pylori eradication itself prevents primary duodenal ulcer recurrence. CONCLUSIONS: The primary peptic ulcer involve many factors in Its etiopathogenesis, being H. pylori the most important of them Although there isn t yet a ideal therapeutic course. The antibiotics play an important role in peptic ulcer and the H. pylori research must be done for na accurate diagnosis and treatment.

Peptic ulcer disease in children

A peptic ulcer in a child looks the same as it does in an adult, and many of the aetiologies of peptic ulcer disease in children are similar to those in adults. However, there are many differences between children and adults, especially in the areas of clinical presentation, the prevalences of different types of ulcer disease, and the prevalence of complications of ulcer disease. Therefore the approach to diagnosis and management in children is often at variance with that in adults. One important example is the approach to suspected Helicobacter pylori(H. pylori) disease in children, in which consensus groups have advised a considerably different approach in children. While the chapter deals with the full range of peptic ulcer disease in children, the focus is on those aspects in which there are differences between adults and children.

Peptic ulcer disease in childhood in Zaria, Nigeria.

Over a 10-year period in a busy paediatric surgical unit, six children were operated upon for peptic ulcer disease, four of whom presented with complications (pyloric stenosis, two; perforation, one; bleeding, one). Truncal vagotomy with a drainage procedure was the operation of choice in five of the children in whom there were no complications. One child suspected of having Zollinger-Ellison syndrome had recurrence of symptoms. Symptoms of peptic ulcer disease in children are non-specific, and in our environment such symptoms are frequently considered to be due to parasitic infestation. Barium meal is not very sensitive in diagnosis in children, and the relative lack of availability of endoscopic services limits pre-operative diagnosis. It is suggested that peptic ulcer disease be considered in children who have persistent or recurrent abdominal pain of obscure aetiology.

Lack of Correlation between Vacuolating Cytotoxin Activity, cagA Gene in Helicobacter pylori , and Peptic Ulcer Disease in Children

Lack of Correlation between Vacuolating Cytotoxin Activity, cagA Gene in Helicobacter pylori , and Peptic Ulcer Disease in Children

Lack of correlation between vacuolating cytotoxin activity, cagA gene in Helicobacter pylori, and peptic ulcer disease in children.

To determine the prevalence of the cagA gene and vacuolating cytotoxin in Helicobacter pylori isolates obtained from children and to characterize the relationship between cagA, cytotoxin production, and ulcerogenesis, pediatric Helicobacter pylori isolates were tested for cagA by the polymerase chain reaction and for vacuolating cytotoxin by a cell culture assay. Helicobacter pylori isolates were obtained from 33 children referred for upper gastrointestinal endoscopy. Twenty-six of these isolates were tested for cagA by the polymerase chain reaction; all 26 (100%) were positive. Of the 26 children from whom these isolates were obtained, 26 (100%) had chronic gastritis and 12 (46%) had duodenal ulcers. Nine (30%) of 30 isolates tested showed expression of vacuolating cytotoxin, only three of which came from patients with duodenal ulceration (odds ratio 0.81, 95% confidence interval 0.1-5.3). Of the 23 cagA-positive isolates tested for cytotoxin, only nine (39%) were positive. There was no association between vacuolating cytotoxin and clinical symptoms, nor was cytotoxicity associated with ulcerogenesis. In summary, the findings suggest that cagA is not a marker of duodenal ulceration or of vacuolating cytotoxin production in children referred for endoscopy.

Perforated duodenal ulcer presenting with shock in a child

Presentation of peptic ulcer disease in children covers a broad spectrum ranging from subtle, and thus overlooked and underdiagnosed, to catastrophic, as in this case. It is important for the emergency physician to realize the potential morbidity and mortality of this disease and be aware of the spectrum of presentation for primary and secondary pediatric ulcer disease.

A 45-year experience with surgical treatment of peptic ulcer disease in children

Peptic ulcer disease (PUD) requiring surgical treatment has become rare with the availability of modern medical management. A retrospective study of all patients who required operations for PUD between 1949 and 1994 (n = 43) was done. The patients were classified into 3 groups: A (n = 38): pre-histamine-2 (H2) blocker era (1949–1975); B (n = 3): pre-hydrogen-potassium (H-K +) ATPase inhibitor era (1976–1988); C (n = 2): H-K + ATPase inhibitor era (1989–1994). Data, analyzed using χ 2 analysis ( P < .01), included preoperative medical therapy, surgical indications, type of operation performed, complications, and postoperative medical therapy. The indication for surgery in group A was bleeding (26), perforation (8), or obstruction (4); in group B the indication was obstruction (2) or perforation (1); in group C the indication was obstruction (1) or bleeding (1). The incidence of obstruction as an indication for surgery did not differ among the groups ( P < .01). Two of the three patients who had surgery for obstruction in groups B and C had biopsy-proven Helicobacter pylori. The postoperative morbidity rate was lower for groups B and C, although not significantly. The relative mortality among the groups did not change ( P > .01). Children with PUD can have complications similar to those of adults with PUD. Since the introduction of H2 antagonists, the recognition and treatment of H pylori, and the use of H-K + ATPase inhibition, the incidence of operations for bleeding and perforation has decreased dramatically. However, the incidence of surgery for obstruction remains the same.

Helicobacter pylori infection in children

The role of Helicobacter pylori in the pathogenesis of peptic ulcer disease, gastritis and gastric malignancy is an area of intense investigation. The epidemiology of H. pylori suggests that the initial infection may occur in childhood. Although there is a strong association between H. pylori infection and peptic ulcer disease in children, the importance of H. pylori in the production of non-specific recurrent abdominal pain and the appropriate approach to therapy remain controversial.

Symptoms of gastritis due to Helicobacter pylori in children.

Infection due to Helicobacter pylori may be associated with gastritis and peptic ulcer disease in children. The aim of this study was to compare the presentation of gastritis due to H pylori with that of gastritis not associated with H pylori infection. The medical records of 296 children who had esophagogastroduodenoscopy were reviewed; 23 (8%) had H pylori gastritis, and 51 had primary gastritis without H pylori infection. Of patients with H pylori, 43% had antral nodularity and 17% had duodenal ulcers. The incidence of epigastric pain, nocturnal pain, postprandial pain, family history of peptic ulcer disease, water brash, vomiting, weight loss, fecal occult blood, and hematemesis was similar between both groups. Periumbilical pain was less common in children with gastritis than epigastric pain, and pain in the periumbilical region was present in only 4% of children with H pylori infection, compared with 31% of patients who had gastritis without H pylori infection. The presence of H pylori should be sought in children having endoscopy for evaluation of upper gastrointestinal mucosal disease.

Helicobacter pylori infection and peptic ulcer disease in children.

Helicobacter pylori infection and peptic ulcer disease in children.

Helicobacter pylori infection and peptic ulcer disease in children.

Peptic ulcer disease is an uncommon disorder in children. The recent upsurge of interest in peptic ulcer disease in children can be attributed to the importance of studies of children in establishing the role of Helicobacter pylori in the pathogenesis of ulcer disease. This review of recent publications focuses on the role of the organism in peptic ulcer disease, the epidemiology of H. pylori, its significance as a cause of symptoms, and recent advances in the treatment of this infection. The increasing evidence that chronic H. pylori gastritis is possibly a significant risk factor for the development of gastric carcinoma is also discussed.

Helicobacter pylori Infection in Recurrent Abdominal Pain in Childhood: Comparison of Diagnostic Tests and Therapy

To determine the role of Helicobacter pylori infection in children with recurrent abdominal pain and the usefulness of serologic tests in screening H pylori infection and monitoring treatment of H pylori-associated gastritis. During a 3 year period, we investigated the presence of serum immunoglobulin G (IgG) antibody to H pylori in 456 children using the high-molecular-weight cell-associated protein H pylori enzyme immunoassay kit. Among the 456 children studied, 218 (age range, 3 to 18 years; mean age, 9.5 years) had symptoms of recurrent abdominal pain (RAP syndrome) with or without vomiting, and the remaining 238 (age range, 3 to 18 years; mean age, 9.8 years) had no RAP (non-RAP syndrome). We performed upper gastrointestinal endoscopy on 111 consecutive children of the 218 with RAP syndrome and obtained mucosal biopsies for culture, histologic analysis, CLO test (Delta West, Perth, Australia), and H pylori detection by polymerase chain reaction. Thirty-eight (17.4%) of 218 children in the RAP group and 25 (10.5%) of 238 children in the non-RAP group were seropositive for H pylori. Of the 111 children endoscoped, 95 were found to be negative, and 12 were positive by all five assays. Specimens from 2 children were negative by culture and the CLO test but positive by the other three assays. Specimens from 1 child were negative by histologic analysis but positive by all other tests. The remaining child was positive for anti-H pylori IgG but negative by all of the other four assays. Upper gastrointestinal endoscopy detected 14 children with peptic ulcer disease (9 duodenal ulcer and 5 gastric ulcer) and 12 with antral nodular gastritis. Only 4 of the 14 diagnosed with peptic ulcer were H pylori positive by all five assays, whereas all 12 children with antral nodular gastritis were H pylori positive. Nine of the 12 H pylori-positive children were treated with a combination of bismuth subsalicylate, amoxicillin, and metronidazole for 2 weeks. Sera obtained at 2, 4, and 6 months after treatment from all 9 children showed a decrease in anti-H pylori IgG titer. Three H pylori-infected children who did not receive any treatment served as control children, and their IgG levels remained elevated or increased over time. The results from our study indicate that screening for the serum IgG antibody to H pylori is a practical method for diagnosing H pylori infection in children, and that serial measurements of the H pylori IgG antibody are useful for monitoring treatment of H pylori because of its high sensitivity and ease of performance. Only 4 of the 14 children diagnosed with peptic ulcer disease were confirmed to be infected with H pylori, whereas all 12 children with antral nodular gastritis were found to be infected by H pylori. These observations suggest that H pylori infection is more frequently associated with gastritis than with peptic ulcer disease in children, and that H pylori gastritis is a cause of RAP syndrome in children.

Peptic Ulcer Disease in Children

The term peptic ulcer disease describes a group of disorders, rather than a single pathologic process. It is recognized increasingly in children, often with long-term ramifications. In the past decade, management of patients who have peptic ulcer disease has changed dramatically. Antacid therapy has given way to treatment with histamine (H2) receptor antagonists, a new class of pharmacologic agents that has fostered a billion dollar industry. Other modalities of treatment have been developed as well, such as cytoprotective agents (sucralfate) and proton pump inhibitors (omeprazole), which are based on research into the pathophysiology of gastric acid disorders. In addition, the discovery of an infectious agent (Helicobacter pylori) that contributes to the formation of peptic ulcers has led to a reevaluation of the traditional approach to diagnosis and treatment of abdominal pain in children. Duodenal ulcers are defined as mucosal defects penetrating the mucosa, submucosa, and muscularis mucosa of the duodenum. Gastric ulcers are defined as mucosal defects that penetrate the muscularis mucosa of the stomach. Primary ulcers are those that have no known underlying cause. Secondary ulcers are associated with a known ulcerogenic event such as stress, burns, or ingestion of nonsteroidal anti-inflammatory medications. A discussion of peptic inflammation that typically does not cause ulceration, such as esophagitis, is beyond the scope of this review.

Peptic Ulcer Disease in Children

The term peptic ulcer disease describes a group of disorders, rather than a single pathologic process. It is recognized increasingly in children, often with long-term ramifications. In the past decade, management of patients who have peptic ulcer disease has changed dramatically. Antacid therapy has given way to treatment with histamine (H2) receptor antagonists, a new class of pharmacologic agents that has fostered a billion dollar industry. Other modalities of treatment have been developed as well, such as cytoprotective agents (sucralfate) and proton pump inhibitors (omeprazole), which are based on research into the pathophysiology of gastric acid disorders. In addition, the discovery of an infectious agent (Helicobacter pylori) that contributes to the formation of peptic ulcers has led to a reevaluation of the traditional approach to diagnosis and treatment of abdominal pain in children. Duodenal ulcers are defined as mucosal defects penetrating the mucosa, submucosa, and muscularis mucosa of the duodenum. Gastric ulcers are defined as mucosal defects that penetrate the muscularis mucosa of the stomach. Primary ulcers are those that have no known underlying cause. Secondary ulcers are associated with a known ulcerogenic event such as stress, burns, or ingestion of nonsteroidal anti-inflammatory medications. A discussion of peptic inflammation that typically does not cause ulceration, such as esophagitis, is beyond the scope of this review.

PEPTIC ULCER DISEASE IN CHILDREN: Diagnosis, Treatment, and the Implication of Helicobacter pylori

Peptic ulcers are a relatively infrequent occurrence in children. Ulcers in the stomach and duodenum are typically secondary to systemic illnesses or drugs in young children; secondary ulcers do not recur. In contrast, duodenal ulcers in older children and adolescents have a relapsing course that is increasingly recognized to be related to coexisting, chronic, active antral gastritis and Helicobacter pylori infection. Antihelicobacter therapy not only heals duodenal ulcers, but it alters the natural history by reducing the frequency of ulcer recurrences. Not all primary duodenal or gastric ulcers in the pediatric population, however, are related to H. pylori; their cause remains unknown. Treatment for these patients requires either antacids, H2 blockers, proton pump inhibitors, or ulcer coating agents for 6-8 weeks along with long-term maintenance therapy.

Peptic Ulcer Disease in Children

Although much of the understanding of the pathogenesis of ulcer disease is derived from data studying adults, there are certain manifestations and presentations that differentiate ulcers in children from those seen in adults. Therapy is aimed at reducing acid or improving mucosal defense. The recent recognition of the association of Helicobacter pylori with acid peptic disease has added to our understanding of the disease process and opened new avenues of therapy.