Peptic Ulcer Disease in Children

Abstract

The term peptic ulcer disease describes a group of disorders, rather than a single pathologic process. It is recognized increasingly in children, often with long-term ramifications. In the past decade, management of patients who have peptic ulcer disease has changed dramatically. Antacid therapy has given way to treatment with histamine (H2) receptor antagonists, a new class of pharmacologic agents that has fostered a billion dollar industry. Other modalities of treatment have been developed as well, such as cytoprotective agents (sucralfate) and proton pump inhibitors (omeprazole), which are based on research into the pathophysiology of gastric acid disorders. In addition, the discovery of an infectious agent (Helicobacter pylori) that contributes to the formation of peptic ulcers has led to a reevaluation of the traditional approach to diagnosis and treatment of abdominal pain in children. Duodenal ulcers are defined as mucosal defects penetrating the mucosa, submucosa, and muscularis mucosa of the duodenum. Gastric ulcers are defined as mucosal defects that penetrate the muscularis mucosa of the stomach. Primary ulcers are those that have no known underlying cause. Secondary ulcers are associated with a known ulcerogenic event such as stress, burns, or ingestion of nonsteroidal anti-inflammatory medications. A discussion of peptic inflammation that typically does not cause ulceration, such as esophagitis, is beyond the scope of this review.