Peptic ulcer in childhood

Introduction Pepticulcer is not common in early childhood, and there are many cases in adolescents. In recent years, due to the wide application of endoscopes in the clinic, the incidence rate has increased. Pediatric age can occur in all age groups, more common in newborns and older children. Gastric ulcers often occur in small infants, mostly stress ulcers, and duodenal ulcers occur mostly in older children. The average incidence of duodenal ulcer in children is about 3 to 5 times higher than that of gastric ulcer. There are more boys than girls, and the general statistics are about 2:1.

Cause

Acute peptic ulcer in children is more than chronic ulcer, secondary to more than primary. Often secondary to severe hypoxia or severe infections (sepsis, pneumonia, gastroenteritis, meningitis), severe malnutrition, large amounts of long-term use of corticosteroids, extensive burns (Curlign's ulcer), neurological damage (cranial When damage, encephalitis, brain tumors and the like are involved in the thalamus, especially in the late stage of the disease, Rokitansky-Cushing's ulcer may be complicated. Excessive gastric acid secretion in the primary is often the main cause. In normal newborns, gastric acid secretion reached a peak at 48 hours, remained high within 1 year old, slightly lower at 1 to 4 years old, and increased after 4 years old.

Secondly, it is a mental factor. 85% of the disease is easy to occur in older children who are good at learning and whose emotions are fluctuating. They are often induced by mental stimulation or trauma. There is no conclusion about genetic problems, but 1/3 of the cases have a family history and have autosomal dominant genetic characteristics. Type O blood is prone to occur. In recent years, it has been found that there is a spirochete in the gastric antrum mucosa of children with peptic ulcer, called Helicobacter pylori (CP), which may be the cause of this disease. It can be confirmed by silver staining, scanning electron microscopy and culture. makes an important impact.

Newborn babies are mostly acute ulcers, often secondary to severe hypoxia or severe infections (such as pneumonia, sepsis, meningitis, etc.) severe malnutrition, extensive burns, nerve damage or a large number of long-term use of corticosteroids. Older children are mostly chronic ulcers, and the ulcers are mostly single and deep. Most gastric ulcers occur in the anterior wall of the stomach with a small bend near the pylorus, rarely in a big bend. Most of the duodenal ulcers are located in the posterior wall of the first segment of the duodenum. In childhood, the ability to regenerate is strong, so the lesions can generally heal faster.

an examination

(a) endoscopy

(2) X-ray barium meal inspection

Because the X-ray can pass through the stomach wall, but can not pass through the tincture, the contour of the stomach and duodenum can be seen on the screen after the child eats the tincture. If a shadow is found on the stomach or duodenal wall, the diagnosis of ulcer disease can be determined. This is called a direct sign. The so-called shadow is the filling shadow of the tincture at the ulcer, that is, the prominent shadow appearing on the stomach and duodenal wall under fluoroscopy. Because the pediatric ulcer is shallow and small, the duodenal ulcer is mostly on the posterior wall of the ball. This position is difficult to observe, so the typical ulcer shadow is not easy to find. Most patients with ulcers can only be inferred by indirect signs, such as the duodenal bulb irritability, that is, when the tincture passes through the ball, the speed is too fast; the pyloric fistula is limited to tenderness. In the perspective of barium meal, the detection rate of duodenal ulcer is about 75%, and the rate of gastric ulcer examination is less than 40%. Therefore, the negative examination of barium meal can not say that the child has no ulcer disease. Because the expectorant is not absorbed, it has no damage to the body, and the operation method is simple and easy for the child to accept. Therefore, the perspective of barium meal is still the first choice for pediatric diagnosis of ulcer disease.

(three) fiber gastroscopy

This test can be used for both HP infection detection and gastric juice analysis. Because the ultra-small diameter gastroscope has been used in clinical practice, the pharyngeal reflex in children is weak, the gastroscope is easier to pass through the pharynx, the success rate is higher, and no accidents will occur, so older children are easy to accept this test method. Through gastroscopy, the position, number, shape and edge of the lesion can be directly observed, so the detection rate of ulcer disease can be as high as 90% to 95%, and it can be used for biopsy and spiral bacillus examination without accidental rash. .

(four) electrogastrogram examination

As with electrocardiograms and EEGs, the electrodes are used to record gastric electrical activity through an electrogastrogram, so the children are painless and can be accepted by children of all ages. The electrogastrogram was compared with the gastroscopy, and the coincidence rate was 53% to 60%. This examination can only be used for screening for ulcer disease, and the diagnosis cannot be confirmed.

Differential diagnosis

The disease should be identified with the following diseases:

(a) gastric cancer

The identification of benign gastric ulcers and malignant ulcers is important. The identification points are shown in Table 18-10. The identification of the two is sometimes difficult. The following situations should be given special attention:

1 middle-aged and elderly people have mid-upper abdominal pain, hemorrhage or anemia in the near future;

2 The clinical manifestations of patients with gastric ulcer have changed significantly or the anti-ulcer drug treatment is ineffective;

3 gastric ulcer biopsy pathology has intestinal metaplasia or dysplasia. Clinically, patients with gastric ulcer should be treated with internal medicine for regular follow-up after endoscopic examination, and close observation until ulcer healing.

(two) chronic gastritis

The disease also has chronic upper abdominal discomfort or pain, and its symptoms can be similar to peptic ulcer, but the periodicity and rhythm of the attack are generally not typical. Gastroscopy is the main method of identification.

(c) stomach neurosis

The disease may have upper abdominal discomfort, nausea and vomiting, or resemble peptic ulcer, but often accompanied by obvious systemic neurological symptoms, mood swings are closely related to the onset. No obvious abnormalities were found in endoscopy and X-ray examination.

(four) cholecystitis cholelithiasis

More common in middle-aged women, often interstitial, paroxysmal right upper abdominal pain, often radiated to the right scapular area, may have biliary colic, fever, jaundice, Murphy sign. Eating greasy food can often be induced. B-ultrasound can make a diagnosis.

(5) Gastrinoma

This disease is also known as Zollinger-Ellison syndrome. It has refractory multiple ulcers or atopic ulcers. It is easy to relapse after subtotal gastrectomy, and is often accompanied by diarrhea and obvious weight loss. The patient's pancreas has non--cell tumor or gastric antral G cell hyperplasia, serum gastrin levels are increased, gastric juice and gastric acid secretion are significantly increased.

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