Peptic Ulcer Disease

There is important evidence to document the involvement of Helicobacter pylori as a causative agent of peptic ulcer disease, antral atrophic gastritis, gastric adenocarcinoma and gastric lymphoma (Konturek et al. 2006a,b). Although these diseases are much more common in adulthood, colonization with this pathogen occurs mostly during childhood. Prevalence rates vary from almost 10% of children under the age of 10 years in industrialized countries to 56.8%-83.1% of children in the poorest Brazilian regions (Bittencourt et al. 2006). In theory, childhood is a good time to eradicate H. pylori because children are usually not infected long enough to develop gastric cancer (Bourke 2005). In this way, gastric cancers may be prevented. However, since prevalence and incidence of gastric cancer are decreasing rapidly in developed nations, screening programs would be extremely expensive. Only in high-risk areas or in families with a strong positive history, a test-and-treat strategy can be justified (Bourke 2005; Graham and Shiotani 2005).

Peptic ulcer disease is much less common in the pediatric population than in adulthood. The classification of peptic ulcers is based on the region of involvement (gastric versus duodenal ulcers) and on the presence or absence of a known etiology (primary or secondary due to an underlying disease). Primary peptic ulcers are associated with H. pylori infection. Gastric ulcers are mostly seen in neonates (with or without the development of gastric perforation) while duodenal ulcers are much more common after the neonatal period.

Drumm et al. (2004) demonstrated that single-contrast barium studies have a high false-negative rate for ulcer disease, when compared with endoscopy. Double contrast studies are indicated because of the higher sensitivity, but cannot be performed in young children and imply a higher radiation dose in all children. When perforation is suspected, however, a single contrast study with a low-osmolar nonionic contrast agent should be performed. As a general rule, endoscopy is the preferred method of choice in the diagnosis of peptic ulcers. It has the highest sensitivity and allows the collection of fragments from the gastric mucosa for diagnosis of the infection and for histopathological analysis (Bittencourt et al. 2006).

An ulcer will be visible on an upper GI study as a round or ovoid collection of barium with radiating folds, consistent with edema/inflammation of surrounding mucosa. On US, thickening of the antro-pyloric mucosa can be seen as well as elongation of the antropyloric canal, persistent spasm and delayed gastric emptying. US is not routinely used for the diagnosis of peptic ulcer disease. The presence or absence of intra-abdominal free air can be seen on an abdominal X-ray (upright, left lateral decubitus or with horizontal beam radiographs) in case of a gastric perforation (Fig. 3.12).

Slijtage Nekwervels
Fig. 3.12. a Stress ulcer disease: free air supine. b Stress ulcer disease: supine radiograph reveals free air due to duodenal ulcer

3.4.3 Gastritis

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Constipation Prescription

Constipation Prescription

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