Department of Pediatrics, National Cheng Kung University and Hospital, and Department of Pediatrics, Kuo General Hospital, Tainan, Taiwan.
J Formos Med Assoc. 2010 Jan;109(1):75-81. doi: 10.1016/s0929-6646(10)60024-1.
BACKGROUND/PURPOSE: Peptic ulcer disease (PUD) in children is relatively rare as compared with adults. This study aimed to assess the etiology, clinical and histological characteristics, and treatment of PUD in children.
All children aged < 18 years with an endoscopic diagnosis of PUD were enrolled in a tertiary referral center. The demographic data, clinical, endoscopic, and histological findings were compared between patients with different causes of PUD.
From 1234 endoscopic examinations, 67 (5.4%) children (median age, 11.4 years) with gastric ulcer (GU; n=27) or duodenal ulcer (DU; n=40) were included. Thirty-two (47.7%) of them had Helicobacter pylori infection and 11 (16.5%) had previous use of non-steroidal anti-inflammatory drugs (NSAIDs). Non-H. pylori, non-NSAID PUD was found in 24 (35.8%) patients. Children with H. pylori-related PUD had a significantly higher mean age, antral chronic inflammatory score, rate of familial PUD, and presence of DU and nodular gastritis than those with NSAID-related and non-H. pylori, non-NSAID PUD (p < 0.01). In contrast, children with NSAID-related PUD had a higher rate of upper gastrointestinal bleeding, associated with acute febrile disease, than those with H. pylori-related and non-H. pylori, non-NSAID PUD (p < 0.05). All but two patients with non-H. pylori, non-NSAID PUD were disease free after H. pylori eradication and proton pump inhibitor treatment for 1-2 months.
In children, H. pylori-related PUD is associated with familial peptic ulcer and the presence of DU. However, short-term NSAID use is correlated highly with GU. The outcome of childhood PUD is good.
背景/目的：与成人相比，儿童患消化性溃疡（PUD）的情况相对较少。本研究旨在评估儿童 PUD 的病因、临床和组织学特征以及治疗方法。
在一家三级转诊中心，所有年龄<18 岁且内镜诊断为 PUD 的儿童均被纳入本研究。比较了不同病因 PUD 患儿的人口统计学资料、临床、内镜和组织学发现。
在 1234 次内镜检查中，有 67 例（5.4%）儿童（中位年龄 11.4 岁）患有胃溃疡（GU；n=27）或十二指肠溃疡（DU；n=40）。其中 32 例（47.7%）有幽门螺杆菌感染，11 例（16.5%）有非甾体抗炎药（NSAID）使用史。24 例（35.8%）为非 H. pylori、非 NSAID PUD。与 NSAID 相关和非 H. pylori、非 NSAID PUD 相比，H. pylori 相关 PUD 患儿的平均年龄、胃窦慢性炎症评分、家族性 PUD 发生率以及 DU 和结节性胃炎的存在显著更高（p<0.01）。相反，与 H. pylori 相关和非 H. pylori、非 NSAID PUD 相比，NSAID 相关 PUD 患儿的上消化道出血率更高，且与急性发热性疾病相关（p<0.05）。除了 2 例非 H. pylori、非 NSAID PUD 患儿外，其余患儿在接受 H. pylori 根除和质子泵抑制剂治疗 1-2 个月后均痊愈。
在儿童中，H. pylori 相关 PUD 与家族性消化性溃疡和 DU 有关。然而，短期 NSAID 使用与 GU 高度相关。儿童 PUD 的预后良好。
