EVALUATION OF CHILD PATIENTS WITH PEPTIC ULCER: A SINGLE CENTER EXPERIENCE

Yıl 2022, , 463 - 470, 17.10.2022

Gülseren Evirgen Şahin , Ferda Özbay Hoşnut , Aysun Tekeli

https://doi.org/10.18229/kocatepetip.1072916

Öz

OBJECTIVE: Data on the incidence of peptic ulcer in childhood and risk factors other than Helicobacter pylori (Hp) are insufficient. The aim of this study is to determine the frequency, clinical findings, risk factors and complications of gastroduodenal ulcer in children.
MATERIAL AND METHODS: The endoscopy reports and file information of the children who underwent esophagogastroduodenoscopy in our center between May 2011 and December 2018 were reviewed retrospectively.
RESULTS: Of the 5892 pediatric patients examined, 448 (7.6%) had peptic ulcers. Of the ulcers evaluated, 69% were duodenal, 27.4% were gastric, and 3.6% were both gastric and duodenal ulcers. The most common (52.2%) symptom was dyspepsia. The most common risk factor in peptic ulcers was Hp (66.5%). Nonsteroidal anti-inflammatory drugs were found to be the second most common (5.8%) risk factor. No risk factor could be demonstrated in 14.95% of the cases. Complications secondary to peptic ulcer disease were detected in 70 (15.7%) of the patients. The complications were; bleeding in 50 (12.7%) patients, gastric outlet obstruction in 11 (2.4%) patients, and perforation in 2 (0.4%) patients.
CONCLUSIONS: Helicobacter pylori infection is the most important risk factor for peptic ulcer in children. However, in cases where Hp cannot be demonstrated, other risk factors should be investigated.

Anahtar Kelimeler

Peptic ulcer disease, Helicobacter pylori, Epidemiology, Risk factors, Complication

PEPTİK ÜLSERLİ ÇOCUK HASTALARIN DEĞERLENDİRİLMESİ: TEK MERKEZ DENEYİMİ

Öz

AMAÇ: Çocukluk çağında peptik ülser sıklığı ve Helicobacter pylori (Hp) dışındaki risk faktörleri ile ilgili veriler yetersizdir. Bu çalışmanın amacı çocuklarda gastroduodenal ülser sıklığını, klinik bulgularını, risk faktörlerini ve komplikasyonları belirlemektir.
GEREÇ VE YÖNTEM: Merkezimizde Mayıs 2011 - Aralık 2018 tarihleri arasında özofagogastroduodenoskopi yapılan çocukların endoskopi raporları ve dosya bilgileri geriye dönük olarak incelendi.
BULGULAR: İncelenen 5892 pediyatrik hastanın 448'inde (%7,6) peptik ülser vardı. Değerlendirilen ülserlerin %69'u duodenal, %27,4'ü gastrik ve %3,6'sı hem gastrik hem de duodenal ülser idi. En sık (%52,2) semptom dispepsi idi. Peptik ülserlerde en sık risk faktörü Hp (%66,5) idi. Nonsteroid antiinflamatuar ilaçlar ikinci en yaygın (%5,8) risk faktörü olarak bulundu. Vakaların %14,95'inde herhangi bir risk faktörü gösterilememiştir. Hastaların 70'inde (%15,7) peptik ülser hastalığına sekonder komplikasyonlar saptandı. Komplikasyon 50 (%12,7) hastada kanama, 11 (%2,4) hastada gastrik çıkış obstrüksiyonu ve 2 (%0,4) hastada perforasyon idi.
SONUÇ: Helicobacter pylori enfeksiyonu çocuklarda peptik ülser için en önemli risk faktörüdür. Ancak Hp'nin gösterilemediği durumlarda diğer risk faktörleri araştırılmalıdır.

Anahtar Kelimeler

Peptik ülser hastalığı, Helicobacter pylori, epidemiyoloji, Risk faktörleri, Komplikasyon

Kaynakça

• 1. Sierra D, Wood M, Kolli S, Felipez LM. Pediatric Gastritis, Gastropathy, and Peptic Ulcer Disease. Pediatr Rev. 2018;39(11):542-49.
• 2. Brown K, Lundborg P, Levinson J, Yang H. Incidence of peptic ulcer bleeding in the US pediatric population. J Pediatr Gastroenterol Nutr. 2012;54(6):733-6.
• 3. Hua MC, Kong MS, Lai MW, Luo CC. Perforated peptic ulcer in children: a 20-year experience. J Pediatr Gastroenterol Nutr. 2007;45(1):71-4.
• 4. Huang FC, Chuang JH, Ko SF. Clinical experience in the treatment of ulcer-induced gastric outlet obstruction in seven children. Acta Paediatr Taiwan. 2000;41(4):189-92.
• 5. Marshall BJ, Goodwin CS, Warren JR, et al. Prospective double-blind trial of duodenal ulcer relapse after eradication of Campylobacter pylori. Lancet. 1988;2(8626-27):1437-42.
• 6. Sung JJ, Kuipers EJ, El-Serag HB. Systematic review: the global incidence and prevalence of peptic ulcer disease. Aliment Pharmacol Ther. 2009;29(9):938-46.
• 7. Joo JY, Cho JM, Yoo IH, Yang HR. Eosinophilic gastroenteritis as a cause of non-Helicobacter pylori, non-gastrotoxic drug ulcers in children. BMC Gastroenterol. 2020;20(1):1-8.
• 8. Yaman A, Kuloğlu Z, Kahveci A, et al. Change of Helicobacter pylori prevalence in a decade among children undergoing endoscopy. Turk J Pediatr. 2016;58(6):579-82.
• 9. Elitsur Y, Lawrence Z. Non-Helicobacter pylori related duodenal ulcer disease in children. Helicobacter. 2001;6(3):239-43.
• 10. Kalach N, Bontems P, Koletzko S, et al. Frequency and risk factors of gastric and duodenal ulcers or erosions in children: a prospective 1-month European multicenter study. Eur J Gastroenterol Hepatol. 2010;22(10):1174-81.
• 11. Egbaria R, Levine A, Tamir A, Shaoul R. Peptic ulcers and erosions are common in Israeli children undergoing upper endoscopy. Helicobacter. 2008;13(1):62-8.
• 12. Huang SC, Sheu BS, Lee SC, et al. Etiology and treatment of childhood peptic ulcer disease in Taiwan: a single center 9-year experience. J Formos Med Assoc. 2010;109(1):75-81.
• 13. Tam YH, Lee KH, To KF, Chan KW, Cheung ST. Helicobacter pylori-positive versus Helicobacter pylori-negative idiopathic peptic ulcers in children with their long-term outcomes. J Pediatr Gastroenterol Nutr. 2009;48(3):299-305.
• 14. Ankouane Andoulo F, Ngatcha G, Tagni-Sartre M, Biwolé Sida M, Ndjitoyap Ndam EC. Helicobacter Pylori infection and peptic ulcer disease in children and adolescents from the age range of 6 to 18 years old in Yaounde (Cameroon). Health Sci Dis. 2015;16(4):1–6.
• 15. Güven B, Sağ E, Usta D, İssi F, Çakır M. Peptic ulcer disease in children. Mucosa. 2020; 3(1): 18-22.
• 16. Ecevit ÇÖ, Özgenç F, Yüksekkaya HA Ünal F, Arikan Ç, Yağci RV. Peptic ulcer disease in children: an uncommon disorder with subtle symptomatology. Turk J Gastroenterol. 2012;23(6):666-9.
• 17. Tumgor G, Agin M, Doran F, Cetiner S. Frequency of Celiac Disease in Children with Peptic Ulcers. Dig Dis Sci. 2018;63(10):2681-86.
• 18. Şimşek H, Tezol O, Gülseren A, et al. Peptic ulcer disease in children with chronic abdominal pain. J Gastroenterol Hepatol Endosc. 2018;3(2): 1043.
• 19. Uğraş M, Pehlivanoğlu E. Helicobacter pylori infection and peptic ulcer in eastern Turkish children: is it more common than known? Turk J Pediatr. 2011;53(6):632-7.
• 20. Erkan T, Kutlu T, Çullu F, Göksel S, Tümay TG. Peptic ulcer in pediatric patients: Retrospective analysis of 41 cases. Cerrahpaşa J Med. 1998;29(2): 848.
• 21. Yörgüç E, Gülerman HF, Kalkan İH, Güven B, Balcı M, Yörgüç MÇ. Comparison of clinical outcomes and FOXP3, IL-17A responses in Helicobacter pylori infection in children versus adults. Helicobacter. 2021;26(3):12795.
• 22. Okuda M, Lin Y, Kikuchi S. Helicobacter pylori infection in children and adolescents. Adv Exp Med Biol. 2019; 1149:107-20.
• 23. Macarthur C, Saunders N, Feldman W. Helicobacter pylori, gastroduodenal disease, and recurrent abdominal pain in children. JAMA. 1995;273(9):729-34.
• 24. Palanduz A, Erdem L, Cetin BD, Ozcan NG. Helicobacter pylori infection in family members of patients with gastroduodenal symptoms. A cross- sectional analytical study. Sao Paulo Med J. 2018;136(3):222-7.
• 25. Sherman PM. Appropriate strategies for testing and treating Helicobacter pylori in children: when and how? Am J Med. 2004;117(5A):30-5.
• 26. Tutar E, Ertem D, Kotiloglu Karaa E, Pehlivanoglu E. Endoscopic and histopathologic findings associated with H. pylori infection in very young children. Dig Dis Sci. 2009;54(1):111-7.
• 27. Cardile S, Martinelli M, Barabino A, et al. Italian survey on non-steroidal anti-inflammatory drugs and gastrointestinal bleeding in children. World J Gastroenterol. 2016;22(5):1877-83.
• 28. Kubosawa Y, Mori H, Kinoshita S, et al. Changes of gastric ulcer bleeding in the metropolitan area of Japan. World J Gastroenterol. 2019;25(42):6342-53.
• 29. Dills R, Anderson LA, Pierce CA. The role of nonsteroidal anti-inflammatory drugs in pediatric patients. Pharmacol Res. 2012;65(1):5-8.
• 30. Chung WC, Jeon EJ, Kim DB, et al. Clinical characteristics of Helicobacter pylori-negative drug-negative peptic ulcer bleeding. World J Gastroenterol. 2015;21(28):8636-43.
• 31. Blatchford O, Murray WR, Blatchford M. A risk score to predict need for treatment for upper-gastrointestinal haemorrhage. Lancet. 2000;356(9238):1318-21.
• 32. Wong GL, Wong VW, Chan Y, et al. High incidence of mortality and recurrent bleeding in patients with Helicobacter pylori-negative idiopathic bleeding ulcers. Gastroenterology. 2009;137(2):525-31.
• 33. Yoon H, Kim SG, Jung HC, Song IS. High recurrence rate of idiopathic peptic ulcers in long-term follow-up. Gut Liver. 2013;7(2):175-81.
• 34. Ciubotaru AD, Leferman CE. Case Report: Peptic ulcer disease following short-term use of nonsteroidal anti-inflammatory drugs in a 3-year- old child. F1000Research. 2020;9(419):1-12.
• 35. Dehghani SM, Haghighat M, Imanieh MH, Tabebordbar MR.. Upper gastrointestinal bleeding in children in Southern Iran. Indian J Pediatr. 2009;76(6):635-8.
• 36. Houben CH, Chiu PW, Lau JY, et al. Duodenal ulcers dominate acute upper gastrointestinal tract bleeding in childhood: a 10-year experience from Hong Kong. J Dig Dis. 2008;9(4):199-203.
• 37. Lee SY. Future candidates for indications of Helicobacter pylori eradication: do the indications need to be revised? J Gastroenterol Hepatol. 2012;27(2):200-11.
• 38. Jaka H, Mchembe MD, Rambau PF, et al. Gastric outlet obstruction at Bugando Medical Centre in Northwestern Tanzania: a prospective review of 184 cases. BMC Surg. 2013;13(1): 41.
• 39. Appasani S, Kochhar S, Nagi B, Gupta V, Kochhar R. Benign gastric outlet obstruction--spectrum and management. Trop Gastroenterol. 2011;32(4):259-66.
• 40. Baltrūnaitė J, Trainavičius K. Perforated peptic ulcer in children: Diagnosis and treatment. Lithuanian Surgery. 2015;14 (1):38–45.