Gastroduodenal ulcers in the Helicobacter pylori era.
The aim of the study was to evaluate the current spectrum of gastroduodenal ulcers in children referred to a regional paediatric unit in the United Kingdom. During a 5-y period (1994-98), all children with a visibly discrete gastric and/or duodenal ulcer diagnosed at endoscopy were prospectively identified. Patients with ulcers associated with Helicobacter pylori gastritis underwent repeat endoscopy 2-3 mo after medical treatment. Thirty-seven children, 21 boys and 16 girls of median age 11 y (range 7 mo to 16 y), had gastric and/or duodenal ulceration. Specific aetiological factors were identified in 21 of 22 with H. pylori negative ulcers, including Crohn's disease (n = 6), coeliac disease (n = 4) and treatment with ulcerogenic drugs (n = 4). Fifteen children (41%) had ulcers associated with H. pylori gastritis, including all 10 children with a chronic ulcer. Endoscopically confirmed ulcer healing was achieved in 14 of these using a 1 wk triple therapy regimen (omeprazole and a combination of two antibiotics). In conclusion, the recognized spectrum and the management of gastroduodenal ulceration have changed during the last decade. Although H. pylori gastritis is an important aetiological factor, a wide range of other conditions needs to be considered. Surgical intervention is only rarely necessary.
Stringer
Department of Paediatric Surgery, Leeds Teaching Hospitals NHS Trust, UK.
Veysi
V T
VT
Puntis
J W
JW
Batcup
G
G
Dixon
M F
MF
D000208:Acute Disease; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D002648:Child; D002908:Chronic Disease; D003937:Diagnosis, Differential; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005500:Follow-Up Studies; D005756:Gastritis / Q000382:microbiology* / Q000473:pathology; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology*; D016480:Helicobacter pylori / Q000302:isolation & purification; D006801:Humans; D015994:Incidence; D008297:Male; D010437:Peptic Ulcer / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology*; D011446:Prospective Studies; D012008:Recurrence; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology
D000900:Anti-Bacterial Agents; D000897:Anti-Ulcer Agents