Epidemiology and pathogenesis in children
The incidence of peptic ulcer disease increases with age. The peak of detection occurs in puberty (55%), while the pathology is significantly less common in primary school children (37%) and preschoolers (8%). Boys are affected 3 times more often than girls. The most typical zone for defect formation is the anterior or posterior wall of the duodenal bulb (bulbus duodeni).
The disease occurs due to the predominance of aggressive factors (hyperproduction of acid and pepsin, Helicobacter pylori, bile reflux) over protective factors (mucus, bicarbonates, regeneration). The neuroendocrine cascade plays an important role: dysfunction of the cerebral cortex causes hypothalamic dysfunction, leading to persistent vagotonia (increased tone of n. vagus). This provokes local mucosal ischemia and hyperactivation of the acid-peptic factor.
Stages of clinical and endoscopic course
The process of development and scarring of the ulcer defect goes through four consecutive stages:
- Stage I (Exacerbation, fresh ulcer). Pronounced pain and dyspeptic syndromes. In gastric ulcer, pain occurs 20–30 minutes after eating, while duodenal lesions are characterized by late (after 1.5–2 hours), "hungry", and nocturnal pain. Palpation reveals defense (muscle rigidity) and a positive Mendel's sign. Endoscopically, a defect with a fibrinous coating and an inflammatory ridge is visible.
- Stage II (Beginning of epithelization). Pain becomes dull, aching, and appears during the day. Endoscopically, the base of the defect is cleared of fibrin, and mucosal edema and hyperemia subside.
- Stage III (Healing). Clinical remission ensues—complaints are completely absent. Granulation tissue and a linear scar form at the site of the ulcer.
- Stage IV (Complete healing). The repair time for the defect itself is 25–30 days for the stomach and 35–40 days for the duodenum. Complete resolution of concomitant inflammation (gastroduodenitis) takes from several months to 2 years.
Diagnostic workup
The gold standard for diagnosis is esophagogastroduodenoscopy (EGD) with targeted biopsy to assess morphology and detect H. pylori. According to indications, contrast radiography with barium sulfate is used: a specific radiological sign of an ulcer is the "niche" sign (accumulation of contrast in the crater).
The mandatory laboratory minimum includes complete blood and urine counts, biochemistry, coprogram, and fecal occult blood test (for bleeding screening). Due to the high risk of hemorrhagic complications, blood type and Rh factor are mandatory for all patients.
In Russian pediatrics, it is important to distinguish between true peptic ulcer disease (a chronic disease according to A.V. Mazurin's classification) and symptomatic ulcers—acute lesions resulting from stress or the use of ulcerogenic drugs, which lack seasonality.
Principles of therapy
Basic treatment includes a protective regimen and strict dietary therapy (frequent, small meals with chemical and thermal sparing according to medical diet table No. 1, transitioning to table No. 15).
The mainstay of pharmacotherapy for H. pylori-positive ulcers is eradication therapy. Due to resistance and toxicity, the first-line regimen in pediatrics typically includes a proton pump inhibitor (PPI), amoxicillin, and clarithromycin (or nifuratel, or josamycin). In case of resistance, therapy switches to sequential or quadruple therapy with the addition of bismuth tripotassium dicitrate. The course lasts 10–14 days.
Efficacy control of eradication is performed using non-invasive tests strictly no earlier than 6 weeks after drug discontinuation.
To remember the relationship between pain and food intake: "The lower the ulcer in the GI tract, the later the pain." In the stomach, it is early (20–30 minutes); in the duodenum, it is late (1.5–2 hours) and "hungry".
Class and exam questions
Does the child's age affect the incidence of complications?
No, the incidence of complicated forms is evenly distributed across all age groups and accounts for about 7–10% of all cases.
What is the difference in terminology between Russia and English-language literature?
In Russia, a distinction is made between true chronic peptic ulcer disease and secondary symptomatic ulcers. In international practice, the umbrella term "peptic ulcer" is used for both conditions.
Why is it difficult to diagnose an ulcer in children based on complaints?
Children often cannot clearly describe the nature and localization of pain, quickly forget pain episodes, and 50% of patients have a completely asymptomatic course.
What else to study on this topic
- Pathogenetic cascade: from cerebral cortex dysfunctions to the development of persistent vagotonia.
- Sequential and quadruple therapy regimens for first-line eradication failure.
- Management of H. pylori-negative peptic ulcer disease and the "on-demand" therapy strategy.
- Prevention of antibiotic-associated diarrhea using Saccharomyces boulardii.
- Features of clinical dispensary follow-up and anti-relapse courses during remission.
Master the entire topic in the Pediatrics course
This is a summary. The course covers everything tested in classes and exams.
- Complete study guide on "Peptic Ulcer Disease of the Stomach and Duodenum" and another 3,738 pages on the subject
- Assignments and quizzes after every topic — just like in a colloquium
- AI tutor answers questions on the topic anytime
- 71 video lessons on the subject
Other topics in "Chapter 7. Digestive System Diseases"
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