Long-term Prognosis of Childhood Duodenal Ulcers
Source: Chan KL, et al. Long-term follow-up of childhood duodenal ulcers. J Pediatr Surg 1997;32:1609-1611.
Chan and associates, pediatric surgeons at the University of Hong Kong, performed a long-term follow-up of 32 children with endoscopically diagnosed duodenal ulcers between 1975 and 1988. Their study evaluated the long-term outcome of childhood duodenal ulcers after initial treatment with H2-receptor antagonists (H2RA).
Thirty-two children admitted into the Queen Mary Hospital with endoscopically proven duodenal ulcers between 1975 and 1988 were reviewed to evaluate the long-term outcome of childhood duodenal ulcers after initial treatment with H2RA. The age of the 22 boys and 10 girls at the time of diagnosis of the ulcers ranged from 3 to 16 years (mean, 11.8 years). The duration of follow-up ranged from 8.5 to 21 years (mean, 11.6 years).
Their primary presentations included epigastric pain (n = 9; 28%); nonsteroidal anti-inflammatory drug (NSAID)-induced gastrointestinal bleeding (n = 6; 18.7%); perforation (n = 4; 12.5%); and pyloric obstruction (n = 1; 3.0%). All 13 patients who had NSAID-induced ulcers (pain and bleeding) responded to H2RA therapy and required no further treatment. All 14 patients who had unprovoked ulcers and presented with pain or bleeding did not respond to H2RA treatment. Ulcer healing was achieved only after eradication of Helicobacter pylori with antibiotics (n = 8) or definitive surgery involving either truncal vagotomy and pyloroplasty (VP) (n = 4) or proximal gastric vagotomy (PGV) (n = 2). The patient who had gastric outlet obstruction had vagotomy and antrectomy. All four patients who had perforation were initially treated with patch repair, but two had persistent ulceration despite H2RA treatment and required PGV. Complications developed in none of the four patients who had PGV, whereas two of the four patients with VP had problems (diarrhea, n = 1; bezoar obstruction, n = 1).
Unprovoked childhood duodenal ulcer is associated with significant long-term morbidity and requires continued follow-up. The majority of the ulcers are resistant to H2RA treatment alone and ultimately require either eradication of H. pylori or surgery. In the absence of obstruction, PGV may be enough to resolve the ulcer diatheses. ach
Endoscopically proven duodenal ulcers in children:
a. have the same therapeutic prognosis regardless of an association or no association with administration of NSAIDs.
b. do not respond to therapy with H-2 receptor antagonists.
c. do not frequently respond to antibiotic eradication of Helicobacter pylori.
d. may require H-receptor antagonist, antibiotic, and surgical treatments for complete cure.
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