Stomach ulcer in children

Peptic ulcer of the stomach and / or duodenum in children is a chronic, cyclically occurring disease characterized by ulceration in the stomach, duodenum, less often in the postbulbar regions.

ICD-10 code

• K25. Stomach ulcer.
• K26. Duodenal ulcer.
• K28. Gastroejunal ulcer.

Epidemiology

Epidemiology of peptic ulcer disease in children

Ulcer disease is one of the most common diseases among the adult population. According to the materials of foreign and domestic statistical studies, peptic ulcer and peptic ulcer of the duodenum, every 10th resident of European countries suffers. Currently, more than 3.5 million patients with this pathology are registered with gastroenterologists.

The prevalence of peptic ulcer disease in children varies from country to country, there is no precise statistics. So, according to the Children's Hospital of British Columbia (Canada), annually from 4 million patients in 4-6 children diagnose new cases of peptic ulcer. According to the Nizhny Novgorod Research Institute of Pediatric Gastroenterology in Russia, the prevalence of peptic ulcer is 1.6 ± 0.1 per 1,000 children. The latest data indicate that the ulcerative process in children in 99% is located in the bulb of the duodenum, 0.5-0.75% in the stomach, and 0.25% of the cases are diagnosed with a combined localization. Ulcerative process in the stomach in children is often acute character of different etiology (stress, trauma, infection, drug damage, etc.). The data were confirmed by the results of a long-term (more than 3 years) regular scheduled clinical-endoscopic observation, which allowed to exclude the chronic ulcerative process in the stomach.

Epidemiological studies based on a thorough study of anamnestic data, clinical endoscopic and functional parallels, allow to establish the frequency of duodenal ulcer depending on the age and sex of the child. The cases of detection of duodenal ulcer in children of the first year of life are recorded, at the preschool age the incidence is 0.4 per 1000, and in schoolchildren 2.7 per 1,000 children. In this case, peptic ulcer disease in girls is more often detected at the age of 10-12 years. And boys - 12-15 years. Sexual differences are not observed until 4-8 years, but with age, a tendency to predominate in the number of boys suffering from duodenal ulcer, over girls in a ratio of 3: 1, reaching by age 18: 5: 1.

[1], [2], [3], [4], [5]

Causes of the stomach ulcer

Causes of peptic ulcer disease in children

Many theories of the development of peptic ulcer (inflammatory-gastritic, cortico-visceral, neuro-reflex, psychosomatic, acido-preventive, infectious, hormonal, vascular, immunological, traumatic) have been proposed, but none of them contain completely changes realized as a ulcerative mucosal defect the shell of the stomach and duodenum. In connection with this, peptic ulcer is considered a polyethological disease with heterogeneity of genetic predisposing factors.

Causes and pathogenesis of gastric ulcer

[6], [7], [8]

Symptoms of the stomach ulcer

Symptoms of peptic ulcer in children

The clinical symptoms of duodenal ulcer are manifold, and a typical picture is not always formed, which greatly complicates the diagnosis.

The classic picture of peptic ulcer is characterized primarily by the typical pain syndrome, which was described for the first time in the early 20th century by Moinigan:

• pain hungry (on an empty stomach or 1.5-2 hours after eating), often - night;
• stubborn paroxysmal, cutting, stitching;
• irradiate in the back, right shoulder, shoulder blade;
• are localized in the epigastrium and to the right of the midline;
• pass after eating, taking antacids or antispasmodics;
• exacerbations seasonal (autumn-spring).

Symptoms of peptic ulcer disease

Forms

Classification of peptic ulcer disease in children

In the English-language literature the terms "peptic ulcer" and "peptic ulcer" are used as synonyms, applying both to erosions, and to ulcers of the stomach and duodenum. Erosion is a mucosal defect that does not penetrate to the muscular plate, while the ulcer is a deeper lesion that goes inside the submucosa.

Peptic ulcer is divided into primary and secondary. There are primary peptic ulcers associated with H. Pylori, and Helicobacter-negative (idiopathic), which are chronic and tend to recur.

The causes of secondary peptic ulcers are various: physiological stress, burns, hypoglycemia, craniocerebral trauma, use of drugs, infections, autoimmune diseases, hypersecretory and immune mediated conditions, vascular insufficiency, cirrhosis, etc. Secondary peptic ulcers depending on etiological reasons can have both acute and chronic course.

The national medical school clearly divides the peptic ulcer and symptomatic ulceration of the gastroduodenal mucosa, which occur in various diseases and conditions.

In pediatric practice, the classification of peptic ulcer according to A.V. Mazurin.

The pathological process can be localized in the stomach, duodenum (bulb and postbulbarnyh departments), it is also possible to combine the lesion. Distinguish the following phases of the disease: exacerbation, incomplete clinical remission and clinical remission. Isolate uncomplicated and complicated forms of peptic ulcer, the latter includes bleeding, penetration, perforation, stenosis of the pylorus and perivistseritis. The functional state of the gastroduodenal zone (acidity of gastric contents, motor skills may be increased, lowered or normal) is to be evaluated. Clinically and endoscopically, peptic ulcer is classified as follows:

• I stage - a fresh ulcer;
• II stage - the beginning of epithelialization of a ulcerative defect:
• III stage - healing of the ulcerative defect with expressed gastroduodenitis;
• Stage IV - clinical endoscopic remission.

[9], [10], [11], [12], [13]

Diagnostics of the stomach ulcer

Diagnosis of peptic ulcer disease in children

When collecting an anamnesis, it is necessary to pay attention to heredity, the nature of nutrition, bad habits and accompanying diseases, the spectrum of medications used, which is burdened with gastroduodenal pathology.

Inspection, palpation, percussion, auscultation is carried out according to the traditional method. In addition to the data obtained, the diagnosis is based on the results of instrumental, morphological and laboratory methods of investigation, including esophagogastroduodenoscopy, pH-metry and diagnosis of H. Pylori infection.

Diagnosis of peptic ulcer disease

[14], [15], [16], [17], [18], [19], [20], [21]

Treatment of the stomach ulcer

Treatment of peptic ulcer disease in children

The purpose of treatment of peptic ulcer disease is the coping of clinical symptoms of the disease and healing of the ulcerative defect, and subsequently - the carrying out of rehabilitation measures aimed at restoring the structural and functional disorders of the gastroduodenal zone and preventing the recurrence of ulcerative process.

An important task is to solve the problem of the place of treatment of peptic ulcer in children. It is generally acknowledged that with a newly diagnosed peptic ulcer, it is mandatory to have an in-patient examination and treatment, adjusted taking into account the history, peculiarities of the child's mental state and psychological climate in the family, school or kindergarten.

How is peptic ulcer treated?

Prevention

Prevention of peptic ulcer disease in children

Primary prophylaxis of peptic ulcer includes monitoring the condition of the upper gastrointestinal tract (especially in children with hereditary heredity of peptic ulcer disease), epidemiological measures aimed at preventing H. Pylori infection, monitoring the adherence to age-appropriate diet and nutrition, promoting healthy lifestyles, and timely eradication treatment in the detection of H. Pylori infection, correction of autonomic dysfunctions.