Gastric - duodenal ulcer in children

The article was written by Dr. CKII Tran Van Quang - Department of Internal Medicine and Pediatrics, Vinmec TImes City International Hospital

Peptic ulcer disease (LDD-TT) is a fairly common disease in adults, accounting for about 5-10% of the population in Vietnam. In the United States, the disease accounts for 10% of the population and the annual cost of treatment is about 4 billion US dollars. In children, the disease has not received much attention, there is a perception that it is a disease only seen in adults, children do not have this disease.
Since the early 70's, the first time people used a flexible bronchoscope for gastroscopy in children and then it was widely used, LDD-TT in children is not uncommon anymore. The disease often presents with abdominal pain, gastrointestinal bleeding and anemia in children. The disease is characterized by a long-lasting course, with a tendency to be chronic and often relapsing.

The disease may present with acute gastrointestinal bleeding such as hematemesis or melena with abdominal pain and acute anemia. If not treated in time, it will cause death due to anemia. But can also develop slowly in the primary ulcer form, which is common in older children, especially children > 6 years of age, the main clinical presentation is similar to that of adults but less typical.
Family history of peptic ulcer. Abdominal pain: accounted for 64.5% of ulcer cases, epigastric pain (60%), pain around the navel or whole abdomen, pain related to meals, pain can be reduced after eating. Children often have pain at night, so they are awakened in the middle of the night or early in the morning (HTT ulcer). Repeated, recurrent, often abdominal pain is the reason why family members take the children to the doctor. Recurrent vomiting, related to meals Feeling uncomfortable, vague epigastric area Gastrointestinal bleeding: Children may vomit blood and pass black stools, the condition can occur massively acutely or develop from word, stretch. Anemia: Usually hypochromic anemia due to occult bleeding but sometimes severe anemia, acute shock. In some cases, the presentation is subtle, only anemia is the prominent symptom, the initial diagnosis is usually anemia of unknown cause. If not detected and treated promptly, there will be complications such as chronic anemia, effects on children's physical development, pyloric stenosis and even cancer related to H.P infection (although very rare in children). small).
Patient 13 T acute ulcer duodenal bulb is causing bleeding

Helicobacter Pylori (HP) was first discovered by two Australian doctors, R. Warren and B. Marshall, in 1982. After many failed attempts, they successfully cultured a bacterium from a gastric biopsy sample and placed it. genus name Campylobacter. Since 1989 this bacterium is officially known as H. Pylori. It is a type of spirochete Gr (-), 0.3-0.5 μm in size, with 4-6 flagella at one end, living in the mucus covering the stomach lining In recent studies, more and more found a close relationship between the incidence and frequency of peptic ulcer recurrence and HP infection.
The route of HP infection is mainly through 2 routes: fecal-oral route and oral-oral route. In addition, there are vomit lines, stomach lines. Infection rates are related to sanitation and food intake.
The rate of HP infection is quite high in people with peptic ulcer disease, more and more studies have found a close relationship between the rate of HP infection and peptic ulcer disease. After entering the stomach, bacteria will reside in the mucous layer covering the stomach surface, thanks to the bacterial adhesion factors that stick to the gastric mucosal epithelium and secrete enzymes and toxins that cause damage. gastric mucosal injury.
To detect HP bacteria, there are several methods such as direct staining, histopathology, rapid test (Urease test) and culture, in which culture is the gold standard for determining HP infection and thereby Antibiogram helps doctors choose the most suitable antibiotic to eradicate HP. Currently, non-invasive diagnostic methods, which are less annoying for patients, are also highly accurate and easy to perform.
Breathing test with C13 radioactive Urea, give the patient a small amount of radioactive C13 bound urea. If the patient has HP infection, HP Urease will rapidly decompose Urea-C13 into Ammonia and Carbon Dioxide. This radioactive carbon dioxide enters the bloodstream, reaches the lungs, and is detected in exhaled air using a spectrometer. Faecal test for HP antigens. ELISA technique to find antigens in stool through a simple and highly sensitive diagnostic kit. This method is suitable for detecting HP in children as well as monitoring HP before and after treatment. Due to the cost, it is not really popular. Saliva and Urine Tests: These tests are based on the detection of IgA or IgG (primarily IgG) anti-HP in saliva and urine. This method is not yet popular.

Eliminating HP bacteria is an important step in the treatment of peptic ulcers, helping to speed up healing and especially effective in preventing recurrence. Usually a combination of 3 drugs to eradicate H.P
Combination of antibiotics used for 1-2 weeks in combination with inhibitors of acid secretion can effectively kill HP. Reducing ulcer-causing factors: inhibiting acid secretion, neutralizing HCl. Enhances anti-ulcer factor, mucosal cover, stimulates mucosal epithelial regeneration and mucus secretion. Eliminate the cause of the secondary ulcer. With many new drugs on the market today, the treatment of peptic ulcers in children has brought many good results, avoiding complications related to surgery such as perforation or narrowing of the stomach.

Peptic ulcer, gastric endoscopy, stomach, gastrointestinal bleeding, abdominal pain, digestion, HP bacteria, treatment of gastric leost dafyu,