Objective To study the clinical manifestations and gastroscopic characteristics of upper gastrointestinal ulcer in children. Methods A retrospective analysis was performed for the children who underwent gastroscopy and were found to have upper gastrointestinal ulcer for the first time at the Endoscopy Center of Shengjing Hospital, China Medical University, from January 2011 to May 2021. According to the cause of the disease, they were divided into primary ulcer group (primary group; n=148) and secondary ulcer group (secondary group; n=25). The clinical data were compared between the two groups. Results A total of 173 children with upper gastrointestinal ulcer were enrolled, with a male/female ratio of 3.9:1. Compared with girls, boys had significantly higher proportions of duodenal ulcer and primary ulcer (P<0.05). Compared with the children aged below 6 years, the children aged 6-14 years had higher proportions of duodenal ulcer and primary ulcer and lower proportions of giant ulcer and multiple ulcers. Of the 148 children in the primary group, 95 (64.2%) had Helicobacter pylori infection. Abdominal pain was the most common clinical symptom and was observed in 101 children (68.2%). Duodenal ulcer was common and was observed in 115 children (77.7%), followed by gastric ulcer in 25 children (16.9%) and esophageal ulcer in 7 children (4.7%). Multiple ulcers were observed in 32 children (21.6%). Seventy children (47.3%) experienced complications, among which bleeding was the most common complication and was observed in 63 children (43.6%). Of the 25 children in the secondary group, abdominal pain was the most common clinical symptom and was observed in 9 children (36.0%), with a significantly lower incidence rate than the primary group (P<0.05); foreign body in the digestive tract was the most common cause of ulcer and was observed in 17 children (68%), followed by abdominal Henoch-Sch?nlein purpura in 5 children (20.0%) and Crohn's disease in 3 children (12.0%). The secondary group had a significantly higher proportion of multiple ulcer or giant ulcer than the primary group (P<0.05). Conclusions Upper gastrointestinal ulcer is more common in boys than girls, and duodenal ulcer and primary ulcer are more common in boys. Children aged 6-14 years often have duodenal ulcer and primary ulcer, and giant ulcer and multiple ulcers are relatively uncommon. Primary ulcer in children has a variety of clinical manifestations, mainly abdominal pain, and duodenal ulcer is relatively common, with bleeding as the main complication. The clinical symptoms and endoscopic manifestations of secondary ulcer are closely associated with the primary causes, and it is more likely to induce huge ulcers and multiple ulcers.
Key words
Upper gastrointestinal ulcer /
Primary ulcer /
Secondary ulcer /
Child
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References
1 Kavitt RT, Lipowska AM, Anyane-Yeboa A, et al. Diagnosis and treatment of peptic ulcer disease[J]. Am J Med, 2019, 132(4): 447-456. PMID: 30611829. DOI: 10.1016/j.amjmed.2018.12.009.
2 周立群, 赵泓, 彭克荣, 等. 消化内镜下诊治儿童上消化道异物1334例回顾性分析[J]. 中华儿科杂志, 2018, 56(7): 495-499. PMID: 29996181. DOI: 10.3760/cma.j.issn.0578-1310.2018.07.005.
3 王宝西. 儿童消化内镜发展的过去 现在与将来[J]. 中国实用儿科杂志, 2018, 33(11): 821-824. DOI: 10.19538/j.ek2018110602.
4 周婷婷, 茅志萍. 奥美拉唑三联疗法治疗小儿消化性溃疡的疗效观察研究[J]. 北方药学, 2021, 18(3): 73-74. DOI: 10.3969/j.issn.1672-8351.2021.03.037.
5 李雨濛, 马军, 段芳龄. ACG临床指南: 幽门螺杆菌感染的治疗[J]. 胃肠病学和肝病学杂志, 2017, 26(6): 601-624. DOI: 10.3969/j.issn.1006-5709.2017.06.002.
6 Kamada T, Satoh K, Itoh T, et al. Evidence-based clinical practice guidelines for peptic ulcer disease 2020[J]. J Gastroenterol, 2021, 56(4): 303-322. PMID: 33620586. PMCID: PMC8005399. DOI: 10.1007/s00535-021-01769-0.
7 廖伟伟, 钟雪梅, 张艳玲, 等. 3765例儿童胃镜检查回顾性分析[J]. 北京医学, 2019, 41(11): 994-996. DOI: 10.15932/j.0253-9713.2019.11.007.
8 何昀, 刘志刚, 贾德勤, 等. 120例消化性溃疡患儿的临床特点及与胃镜下病理特征的关系研究[J]. 医学理论与实践, 2021, 34(2): 301-303. DOI: 10.19381/j.issn.1001-7585.2021.02.062.
9 Tuo B, Wen G, Wei J, et al. Estrogen regulation of duodenal bicarbonate secretion and sex-specific protection of human duodenum[J]. Gastroenterology, 2011, 141(3): 854-863. PMID: 21699784. PMCID: PMC3163800. DOI: 10.1053/j.gastro.2011.05.044.
10 Tang Z, Shi J, Ji M, et al. The characteristics of 83 giant peptic ulcers in Chinese children: evaluation and follow-up[J]. Saudi J Gastroenterol, 2018, 24(6): 360-364. PMID: 30136703. PMCID: PMC6253915. DOI: 10.4103/sjg.SJG_147_18.
11 黄艳. 540例儿童消化性溃疡临床分析[D]. 重庆: 重庆医科大学, 2016.
12 李兴川, 王海东, 张妮, 等. 中国儿童及青少年幽门螺杆菌感染流行病学调查的系统评价和meta分析[J]. 临床儿科杂志, 2017, 35(10): 782-787. DOI: 10.3969/j.issn.1000-3606.2017.10.016.
13 秦璟灏. 幽门螺旋杆菌阳性消化性溃疡的中西医病因及临床特征分析[J]. 中医临床研究, 2019, 11(13): 38-41.
14 Milosavljevic T, Kosti?-Milosavljevi? M, Jovanovi? I, et al. Complications of peptic ulcer disease[J]. Dig Dis, 2011, 29(5): 491-493. PMID: 22095016. DOI: 10.1159/000331517.
15 潘火云. 328例儿童消化性溃疡单中心临床分析[D]. 苏州: 苏州大学, 2018.
16 Hokama A, Kishimoto K, Ihama Y, et al. Endoscopic and radiographic features of gastrointestinal involvement in vasculitis[J]. World J Gastrointest Endosc, 2012, 4(3): 50-56. PMID: 22442741. PMCID: PMC3309893. DOI: 10.4253/wjge.v4.i3.50.
17 Han Y, Jin SY, Kim DW, et al. Endoscopic and microscopic findings of gastrointestinal tract in Henoch-Sch?nlein purpura: single institute experience with review of literature[J]. Medicine (Baltimore), 2019, 98(20): e15643. PMID: 31096484. PMCID: PMC6531244. DOI: 10.1097/MD.0000000000015643.