| Objective To explore the causes, clinical manifestations of peptic ulcer (PU) in children for early diagnosis and treatment.Methods Clinical data of86cases with PU hospitalized in Children’ Hospital of Chongqing Medical University between April2006to May2011were reviewed retrospectively.Results(1) There were64males and22females of the86cases with PU.16.3%were in1month to3years old group.23.3%,12.8%,26.7%and20.9%occurred in3to6,6to9,9to12and12to15years old groups respectively. The incidence of duodenal ulcer (DU)(65.1%) was significantly higher than that of gastric ulcer (GU)(29.1%)(P<0.05).DU mainly occurred in children more than9years old, while GU happened more often in children less than6years old (P<0.05)(2) The causes of PU among the86cases were as follows: Helicobacter pylori (Hp) infection (23.3%), drugs effect (22.1%), unhealthy eating habits (16.3%), unclear causes (30.2%)(3) There were20cases with Hp-related PU, none in1month to3 years old group,3cases(15.0%)in3to6years old group,3cases(15.0%) in6to9years old group,6cases (30.0%) in9to12years old group and8cases (40.0%) in12to15years old group.(4) The common complications included gastrointestinal bleeding and anemia (73.3%), hemorrhagic shock (3.5%), duodenal obstruction or incomplete obstruction (5.8%), pyloric obstruction or incomplete obstruction (3.5%), duodenal bulb perforation (1.2%)(5) The clinical manifestations of86cases with PU were as follows: abdominal pain (73.3%)(22.1%in the upper abdomen,16.3%around the navel,22.1%in the upper middle quadrant and12.8%elsewhere or unclearly;26.7%with mild pain,12.8%with moderate pain,14.0%with severe pain and19.8%with the pain described unclearly); nausea or vomiting (77.9%), haematemesis (44.2%), haematochezia (55.8%), anorexia (61.6%), listless or dysphoria (65.1%);abdominal tenderness (60.5%)(15.1%in the upper abdomen,7.0%around the navel,27.9%in the upper middle quadrant and10.5%elsewhere)(6) The blood type of18patients (46.2%,18/39) with PU was type O, and7patients (8.1%,7/86) had family history of PU.(7) There were remarkable differences between Hp-related and drugs-related PU on age, onset, duration, abdominal pain, family history, endoscopic findings (P<0.05)(8) PU and gastrointestinal ulcers of henoch-schonlein purpura (HSP) were also compared. It turned out that the onsets, abdominal pain (including the localizations, degrees, patterns and regularity), haematochezia, localizations of abdominal tenderness, fecal occult blood tests (FOBT) and endoscopic findings between the two groups were different s ignific antly (P<0.05)Conclusions(1) Boys were prone to PU than girls. DU was the most common in PU and it was apparently connected to age. DU was more likely to occur in elder children, while GU in infants, toddlers and preschool children.(2) Hp infection and drugs effect were the first2main causes of PU in children.(3) The positive rate of Hp detection in children with PU was low, but it was in proportion to age.(4) Gastrointestinal bleeding and anemia were more common than hemorrhagic shock, duodenal and pyloric obstruction or incomplete obstruction, duodenal bulb perforation in the complications of PU.(5) There were wide varieties of clinical manifestations of PU, such as abdominal pain (in the upper abdomen, around the navel or upper middle quadrant), nausea, vomiting, haematemesis, haematochezia, anorexia, listless or dysphoria, abdominal tenderness (in upper abdomen,around the navel or in upper middle quadrant), and so on, but partial patients had no abdominal pain. It was easy to be misdiagnosed because of the atypical manifestations of PU in children.(6) PU could be associated with hereditary factor.(7)There was high morbidity of Hp-related PUin elder children, and its features included obscure onset, longer duration, dull abdominal pain and outbreak during hunger or midnight. Endoscopic finding of Hp-related PU was single ulcer in the duodenal bulb, accompanied by mucosal noduls or verrucous uplift, which were helpful in diagnosis of the disease. However, drugs-related PU mainly occurred in children less than6years old, and its different features included acute onset, shorter duration, prominent hematemesis and haematochezia, and multiple ulcers in stomach by gastroscopy.(8) Compared to PU, the features of gastrointestinal ulcers of HSP included irregular, sharp pain around navel or in lower abdomen with bloody stool, fugitive abdominal tenderness, and multiple ulcers in stomach and duodenum with mucosal erosion, bleeding by gastroscopy, which played an important role in the differential diagnosis.(9) Upper gastrointestinal endoscopy is a valuable method for the diagnosis of PU in children. Methods of Hp detection should be carried out as many as possible to improve the positive rate of Hp detection. |
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