Pediatric emergency medicine trisk 2051 2051
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Stress-related ulcers are common causes of PUD in early infancy.
The most common causes of PUD in older children are Helicobacter
pylori (H. pylori ) and nonsteroidal anti-inflammatory drug (NSAID)
usage.
Gastric outlet obstruction from PUD should be considered in the
child with chronic nonspecific abdominal symptoms and frequent
nonbilious emesis of both liquids and solids at time of presentation.
Proton pump inhibitors (PPIs), if discontinued abruptly, may result in
rebound hypersecretion and exacerbation of symptoms.
Clinical Evidence
While the term PUD describes a group of disorders which involves changes to
the mucosal lining of the upper GI tract (esophagus, stomach, and duodenum),
this section will focus on diseases of the stomach and duodenum. PUD has
various levels of severity with the most common causes of ulcers in stomach
and duodenum being H. pylori infection followed by NSAIDs and
corticosteroids. Less common etiologies include stress-induced gastropathy,
portal gastropathy, caustic ingestion, inflammatory bowel disease (IBD),
eosinophilic gastritis, Zollinger–Ellison syndrome, and other infectious (e.g.,
cytomegalovirus) agents.
Ulcer disease occurs when there is an imbalance between cytotoxic factors
(e.g., acid, pepsin, NSAIDs, H. pylori ) and cytoprotective factors, including
the secretion of mucus and bicarbonate by superficial epithelial and mucous
cells in the upper GI tract. Local blood flow, delayed gastric emptying,
duodenal reflux, and other factors have been suggested as important factors in
the development of gastric ulceration.
H. pylori produces a localized inflammatory reaction that contributes to
epithelial damage either by direct toxic effect or via immunopathologic
means. H. pylori infection usually occurs in childhood with earlier acquisition
and higher prevalence with increasing age noted in developing countries.
There are higher prevalence rates among family members and institutionalized
populations, suggesting person-to-person transmission via either an oral route
or a fecal-to-oral route. A family history of ulcer disease is typically present in
50% or more of children with duodenal ulcers.
Clinical Considerations
