Peptic ulcer disease in children: Diagnosis and treatment

This article is professionally consulted by Master, Doctor Vu Quoc Anh - Pediatrician - Pediatrics - Neonatology Department - Vinmec Danang International General Hospital. The doctor has nearly 10 years of experience as a resident and treating physician.

Peptic ulcer disease is an inflammatory disease and loss of mucosal organization limited to the part of the digestive tract that secretes acid and pepsin. The disease is often overlooked because adults mistakenly believe that children have common digestive diseases such as digestive disorders, stomach worms,...

1.1. History The doctor will examine you by asking questions to determine the condition of the child:
Location of pain, duration of pain, pain or constant pain, does pain spread to other places, pain intensity, pain Is it related to bowel movements or meals, does it increase with eating, ways to relieve pain, symptoms associated with pain, number of times per week, per month, anyone in the family? Did the child take any medicine that affects the stomach, did he change his diet before the pain? Have a fever? Do you have yellow urine? Do you have painful urination? 1.2. Examination Clinical signs and symptoms of peptic ulcer are very poor, so starting from the diagnosis of exclusion. Look for signs of anemia, examine all organs: liver, gallbladder, urinary tract, rectal examination. Look for signs of malnutrition. Occasionally, signs of complications such as gastrointestinal bleeding (melena, vomiting blood, anemia) or pyloric stenosis are seen.
1.3. Recommend X-ray examination of the stomach and duodenum. Gastroduodenal endoscopy: More accurate than X-ray, through endoscopy, biopsy is needed to examine histopathology.

Complete blood count, liver enzymes, blood amylase, urinalysis, fecaloscopy, ultrasound: When necessary to rule out other causes of abdominal pain. 1.4. Possible diagnosis Epigastric pain when eating, vomiting, black stools, family history of peptic ulcer are factors that help in the diagnosis. There were no symptoms of other organ disease, other tests were normal.
1.5. Primary or secondary diagnosis?

1.6. The diagnosis was confirmed by X-ray of the stomach with baryte preparations showing edematous mucosa and drug accumulation. Endoscopy can show redness, congestion, ulcers, irregular mucosa, bile reflux. Histological examination: During gastroscopy, biopsy the antrum 2cm from the pyloric foramen, staining with eosin and trichome for Helicobacter Pylori. 1.7. Differential diagnosis Functional abdominal pain: sudden peri-umbilical pain usually occurs in the evening, with abnormal movement during pain, headache, dizziness. Disorders of biliary tract spasm: Gallbladder pain, Murphy's point, vomiting, yellow eyes. Cholecystitis: Pain, vomiting, fever, jaundice, abnormal ultrasound. Common bile duct cyst: Abdominal mass, abdominal pain, ultrasound with fluid cyst. Hepatitis: Mild fever, conjunctival yellowness, yellow urine, enlarged liver, increased liver enzymes. Pancreatic injection: Acute severe pain, increased amylase.

2.1. General principles of treatment Based on pathology to rule out pathogenic factors such as spirochetes, Helicobacter pylori, stress, increased secretion of HCl,... Normalize gastric function. Enhance mucosal regeneration, eliminate comorbidities. 2.2. Treatment goals a) Reduce ulcer-causing factors
Use drugs that inhibit the secretion of HCl and Pepsin. Use drugs to neutralize HCl secreted into the stomach - duodenum. b) Enhance protective factors
Use mucosal coatings and ulcer dressings. Take medications that stimulate mucus production. c) Eradicate Helicobacter pylori
Treat with antibiogram if HP is detected.

If a child has symptoms of peptic ulcer disease, which recur many times, parents need to quickly take the child to a medical facility for examination, consultation and treatment.