儿童上消化道溃疡173例临床分析北大核心CSCD

目的 探讨儿童上消化道溃疡的临床表现和胃镜特点。方法 对2011年1月至2021年5月于中国医科大学附属盛京医院内镜中心完成胃镜检查并首次发现上消化道溃疡的0~14岁患儿进行回顾性研究。根据病因不同分为原发性溃疡组(简称原发组,n=148)和继发性溃疡组(简称继发组,n=25)。比较两组患儿的临床资料。结果 共纳入173例上消化道溃疡患儿,男女比例3.9∶1。与女孩相比,男孩的上消化道溃疡中十二指肠溃疡和原发性溃疡的占比较高(P<0.05)。与6岁以下儿童相比,6~14岁儿童十二指肠溃疡和原发性溃疡占比较高,巨大溃疡和多发溃疡少见。原发组148例患儿中,幽门螺杆菌的感染率为64.2%(95例);腹痛是最常见的临床症状,共101例(68.2%);十二指肠溃疡多见(115例,77.7%),其次为胃溃疡(25例,16.9%)及食管溃疡7例(4.7%);多发溃疡32例(21.6%);出现并发症的有70例(47.3%),其中最常见的为出血(63例,43.6%)。继发组25例患儿中,最常见的临床症状也是腹痛(9例,36%),但较原发组发生率低(P<0.05);引发继发性溃疡最常见的原因是消化道异物,共17例(68%),其次是腹型过敏性紫癜5例(20%)及克罗恩病3例(12%);出现多发溃疡及巨大溃疡的比例较原发组高(P<0.05)。结论 儿童上消化道溃疡男孩多发,且男孩多为十二指肠溃疡和原发性溃疡。年长儿的上消化道溃疡多为十二指肠溃疡和原发性溃疡,巨大溃疡和多发溃疡相对少见。原发性溃疡临床表现多样,以腹痛为主,十二指肠溃疡多见,并发症以出血为主;继发性溃疡的临床症状及内镜表现与其原发病因密切相关,并且更易诱发巨大溃疡和多发溃疡。     

Lipschütz ulcer in a 17-month-old girl: a rare manifestation of Epstein–Barr primoinfection

Lipschütz ulcer is an uncommon entity that is clinically characterised by a flu-like syndrome accompanied by an acute painful necrotic vulvar ulcer. It typically occurs in young women with no sexual contact history, and it is very rare among children. The aetiology is unknown, although recently several reports have related Epstein–Barr virus primary infection with this entity. We report a 17-month-old girl with fever and an acute genital ulcer. All the complementary tests for the most frequent causes of vulvar ulcers yielded negative results, whereas viral serology and polymerase chain reaction technique confirmed the presence of an acute Epstein–Barr virus infection. When main causes of genital ulcer have been excluded, and there is no history of sexual contact, Lipschütz ulcer should be included in the differential diagnosis. Detection of Epstein–Barr virus genome by polymerase chain reaction can lead to an earlier diagnosis.     

Perforated gastric ulcer in the child: a rare complication, a case report]

Perforated gastric ulcer is unusual in children. We report a case in a girl with an unexpected evolution. CASE REPORT: A 13-year-old girl was admitted for abdominal pain. She had no particular personal history but her father had a perforated ulcer. On admission she was not painful, her abdomen was soft on palpation. The white blood cell count was 1.7 x 10(3)/mm3. A right pneumoperitoneum was seen on an abdominal X-ray film. Because of her good general status and the normalization of the abdominal X ray film six hours later, no surgical exploration was performed. On the fourth day, a gastrointestinal endoscopy showed an anterior gastric ulcer which was perforated. Biopsies did not isolate H. pylori. The patient was given a treatment with amoxicillin-metronidazole (7 d) and oméprazole (7 weeks). An endoscopic control, one month later, showed a total healing of the gastric ulcer. CONCLUSION: Peptic ulcerations and their complications are underdiagnosed in childhood. This could lead to delay in diagnosis or inappropriate treatment specially in case of perforation.     

Solitary rectal ulcer in a 12-year-old girl: an unusal cause of rectal bleeding in childhood

Solitary rectal ulcer syndrome is a very rare cause of rectal bleeding in both children and adults. It is of importance in that it may mimic other, more serious rectal pathology such as Crohn's disease, ulcerative colitis, villous papilloma, or carcinoma. We report an unusual cause of rectal bleeding in a child due to solitary rectal ulcer syndrome with a review of the literature.     

A rare cause of severe periorbital edema and dermonecrotic ulcer of the eyelid in a child: brown recluse spider bite

Spider bites are a worldwide problem. Brown recluse spider bites can lead to severe local or systemic clinical effects, such as edema, necrotic ulcer, rashes, fever, chills, nausea, vomiting, malaise, arthralgia, myalgia, hemolysis, leukocytosis, disseminated intravascular coagulation, renal failure, and death. Eyelid bites from brown recluse spiders are rare. We report a child with severe facial edema and a dermonecrotic ulcer on the eyelid. Upon laboratory examination, leukocytosis with a significant left shift was detected. The patient was treated with antibiotics, systemic corticosteroid and conservative therapy that included saline compresses and ocular lubrication. No surgical excision was required. Vision was not impaired. A dermonecrotic ulcer is a severe complication of brown recluse spider bites. Since the diagnosis is difficult, clinical and epidemiological findings and a detailed history are important for an accurate diagnosis.     

Peptic ulcer

OBJECTIVE: To present a current review about pathogenesis, pathophysiology, diagnosis, and treatment of peptic ulcer disease in children, based on the reviewed publications and the author personal experience. METHODS: We revised the most relevant articles about peptic ulcer in children, published from the last 20 years. RESULTS: The gastroduodenal peptic ulcer is very common in adults, mostly in the developing countries. Although it is less frequent in children, the optical fibroendoscopy has improved the number of diagnosed cases. The peptic ulcer is classified as its etiology in primary and secondary. The secondary peptic ulcer is related to a subjacent disease or use of drugs, while the primary ulcer happens in the absence of underlying systemic diseases The primary duodenal ulcer is the most common presentation, and there are strong evidences of the H. pylori association in the etiology. Clinical presentation changes with age and ulcer type. Secondary ulcers are mostly acute and sometimes dramatic, while the primary ones have a chronic evolution mostly similar to patients with functional recurrent abdominal pain, but the presence of epigastric pain, feeding-related pain, vomiting, bleeding, familiar history for peptic ulcer, nocturnal pain, and male gender are strongly related to peptic ulcer. The acid antisecretory agents have great efficacy on relieving symptoms and solving ulcerate lesion, although the H. pylori eradication itself prevents primary duodenal ulcer recurrence. CONCLUSIONS: The primary peptic ulcer involve many factors in Its etiopathogenesis, being H. pylori the most important of them Although there isn t yet a ideal therapeutic course. The antibiotics play an important role in peptic ulcer and the H. pylori research must be done for na accurate diagnosis and treatment.     

Steroid therapy and duodenal ulcer in infants

Two infants with acute life-threatening complications of duodenal ulcer following steroid administration are described. Although the possible association between steroid therapy and peptic ulcer disease is well known, the need for ulcer prophylaxis during such therapy in infants is not unanimously accepted. The case for ulcer prophylaxis in this setting is presented.     

Duodenal ulcer in sickle cell anemia

A 14-year-old black male with sickle cell anemia developed a duodenal ulcer that masqueraded as sickle cell-related abdominal pain crisis on multiple occasions. Malingering and poor therapeutic compliance aggravated the ulcer in this patient, who ultimately succumbed to a catastrophic bleed. Duodenal ulcer appears to be an infrequent but difficult to treat lesion in sickle cell disease. An in-depth review on the occurrence of duodenal ulcer in sickle cell anemia is presented. The etiological mechanisms of peptic ulcer disease in this population and the potential benefits of transfusion therapy are discussed.     

The use of H2-receptor antagonist in the treatment of peptic ulcer disease in children

We report our 20 years' experience on the management of 78 children with primary chronic peptic ulcer, giving special emphasis to the recent 32 patients (29 duodenal ulcer, 3 gastric ulcer) who received H2-antagonist therapy guided by endoscopic surveillance. The most striking observation was the marked decrease in the incidence of "failed medical treatment necessitating surgery" from 34.8% (16/46) in the pre-H2-antagonist era to 3.1% (1/32) in the H2-antagonist era. H2 antagonist was uniformly well tolerated and without side-effects. In 29 patients with duodenal ulcer, a 6-week therapeutic course resulted in complete ulcer healing in 22 (75.9%). Further therapeutic courses resulted in complete ulcer healing in four additional patients (13.8%). There was only partial ulcer healing in two patients (6.9%) and nonhealing in one patient (3.49%). There were 11 episodes of recurrence in nine patients (symptomatic 5, asymptomatic 6). Recurrence was more frequent when nocturnal-dose maintenance was not given (8/11 recurrences). All recurrences responded satisfactorily to further H2-antagonist therapy. Patients with gastric ulcer responded even more favorably, all three healing completely with a single therapeutic course and not requiring maintenance therapy. We conclude that H2-antagonist is safe and highly effective for healing peptic ulcer in children. For duodenal ulcer, maintenance therapy ensures a satisfactory remission rate.     

Duodenal ulcer in a newborn infant with gastro-intestinal hemorrhage (author's transl)]

A newborn infant was transferred to our hospital because of gastro-intestinal hemorrhage, starting a few hours after birth. Because of fetal distress a cesarean section had been necessary. The clinical examination as well as the results of the laboratory tests revealed nothing abnormal. In an upper gastro-intestinal X-ray series there was evidence for a duodenal ulcer. Under conservative treatment the baby recovered and has remained in a good condition without any bleeding episode until now. A repeat upper gastro-intestinal X-ray series was done at the age of 5 months and no evidence of ulceration could be found. The incidence and the reason of such an ulcer in the new born period is shortly discussed.     

Diagnostic upper GI endoscopy for hemetemesis in children: Experience from a pediatric gastroenterology centre in North India

Upper GI endoscopies were done in 236 children (upto 12 years of age) presenting with history of hemetemesis. Varices were the commonest lesions (in 39.41%) followed by esophagitis (23.73%). Gastritis, gastric ulcer, duodenal ulcer and oesophageal ulcers were identified in 7.20%, 1.27%, 0.42% and 0.42% cases respectively. Cause of bleeding could not be ascertained in 27.54% cases. No significant premedication or procedure related complications were observed. Upper GI endoscopy is thus a safe and useful mode of investigation in cases of hemetemesis in children.     

Barrett's ulcer and Campylobacter-like organisms infection in a child

Barrett's esophagus is a gastrointestinal metaplasia of the esophageal epithelium occurring frequently in adults with long-standing peptic esophagitis. Recent reports of Barrett's esophagus in children with gastroesophageal reflux (GER) showed that also at the pediatric age intestinal metaplasia of the esophagus may occur in association with peptic esophagitis. Recently a close association between Campylobacter-like organisms (CLOs) and gastritis has been found in the stomach of both adults and children with a variety of peptic diseases, but evidence of such infection in specimens of Barrett's epithelium has never been described in children. We report here a child with Barrett's esophagus and GER, treated with H2 blockers, who showed a Barrett's ulcer in association with CLO infection. The addition of amoxicillin to antireflux treatment was accompanied by healing of the ulcer, suggesting that bacterial infection of Barrett's epithelium may have an important role in determining its inflammation and possibly ulceration.     

Gastrointestinal tract ulcers in pediatric intestinal transplantation patients: etiology and management

One of the observed complications in patients after intestinal transplantation is the occurrence of ulcers in the native or transplanted gastrointestinal tract. Previous reports have described the appearance of ulcers but have not described any systemic approach to accurately diagnose the etiology of the ulcer. We evaluated 112 intestinal transplantation patients at our institution, in which endoscopic examination identified ulcer formation in 11 patients. No common or defining demographic or clinical variables were found in the patients with ulcers. Biopsies were obtained from the ulcer edge as well as the intervening mucosa. The most common changes in the ulcers were compatible with post-transplant lymphoproliferative disorder (PTLD), acute rejection, and viral infections. These changes could occur simultaneously and retrospective analysis showed that ulcers could have concomitant etiologies. Endoscopically directed biopsies of ulcer edges often displayed morphologic changes compatible with acute rejection of the graft. Some patients were treated for rejection based on the changes within the mucosa outside the ulcer bed, and they responded with resolution of the ulcers. Our findings demonstrate that PTLD and acute rejection are the most common causes of chronic ulcer formation and reinforce the concept that biopsy samples should be collected simultaneously from both the ulcer edge and intervening mucosa.     

Is peptic ulcer a common cause of upper gastrointestinal symptoms?

 The aim of the study was to investigate retrospectively a cohort of children with peptic ulcer disease during a period that covers the recent changes in diagnosis and management of the disease. Over a period of 9 years, 2550 children underwent upper gastrointestinal endoscopy for various reasons. All children, in whom a diagnosis of primary peptic ulcer was established, were included in the study. Previous and current medical history, family history, endoscopic and histological outcome were evaluated and the children were regularly followed-up on an out-patient basis. Primary peptic ulcer was diagnosed in 52 (10 gastric and 42 duodenal, 2%) out of 2550 children. The median age of children with gastric ulcer was 6.5 years, whereas of those with duodenal ulcer was 10.5 years (P=0.04). With regard to clinical symptoms no significant difference was found between children with and without ulcer. The prevalence of Helicobacter pylori infection was significantly higher in children with duodenal ulcer (62%) compared to those with gastric ulcer (20%; P<0.001). At first follow-up visit, 1 month after the end of treatment, 19 symptomatic children underwent a repeat endoscopy, which showed ulcer healing in 95% and failure in H. pylori eradication in 27%. During the long-term follow-up (median 3.5 years), six children became symptomatic. Two of them had duodenal ulcer associated with positive H. pylori. Conclusion Peptic ulcer disease is an uncommon disorder in childhood with non specific clinical features; it seems that efficient treatment and successful Helicobacter pylori eradication result in clinical improvement and cure as well as in long-term healing of ulcers. Received: 25 September 2000 and in revised form: 22 February and 28 March 2001 / Accepted: 29 March 2001     

Clinico-genetic problems of peptic ulcer in children]

Based on the results of 11200 endoscopies of the stomach and duodenum, the incidence of peptic ulcer in children was established with regard to the sex and site of ulcer. The authors view peptic ulcer as a heterogeneous disease in terms of the genealogical data and differences in proteolytic activity of gastric proteases in biological media.     

PEPTIC ULCER DISEASE IN EARLY INFANCY: CLINICAL PRESENTATION AND OENTGENOGRAPHIC FEATURES

Abstract. Johnson D., L'Heureux, P. and Thompson, T. (Departments of Pediatrics and Radiology, University of Minnesota School of Medicine, Minneapolis, Minnesota). Peptic ulcer disease in early infancy: Clinical presentation and roentgenographic features. Acta Paediatr Scand, 69:753, 1980.—Sixteen infants under 11 weeks of age developed documented peptic ulcer disease involving the stomach, duodenum or pylorus during an eight-year period in a Newborn Intensive Care Unit. The precipitous onset of gastrointestinal bleeding and/or perforation commonly associated with ulcer disease in early infancy was present in only seven (44%) of the 16 patients. The remaining nine infants (56%) presented with recurrent emesis, a presentation of peptic ulcer disease rarely described in the first weeks of life. Contrast radiography was used to demonstrate a definite ulcer crate in 13 of these patients. Two had their ulcers diagnosed at surgery and one by endoscopy. Radiographic demonstration of pylorospasm and/or gastric retention was often associated with ulcer craters located in the pyloric channel or gastric antrum. Only two patients required surgery for massive bleeding and perforation. The remainder were successfully managed medically using orogastric suction, antacids and gradual resumption of milk feedings. There were no deaths within our population attributable to peptic ulcer disease.     

Inflammatory Cloacogenic Polyp in a Child: Part of the Spectrum of Solitary Rectal Ulcer Syndrome

A 15-year-old boy with Marshall-Smith syndrome presented with increased frequency and urgency of stooling, hematochezia, and rectal pain. A polypoid mass was found at the anorectal junction and excised. Microscopically, the lesion was covered by both squamous and columnar mucosa. It was villiform in configuration with focal ulceration and strands of smooth muscle in the lamina propria. These features are characteristic of an inflammatory cloacogenic polyp, a lesion not previously reported in the pediatric age group. Inflammatory cloacogenic polyp is related to solitary rectal ulcer syndrome and is most likely due to prolapse of the anorectal transition zone. Although rare in this age group, solitary rectal ulcer and its variants should be considered in the differential diagnosis of anorectal and rectal lesions in the pediatric patient.     

Gastrointestinal bleed in a toddler secondary to chronic renal failure and hyper-gastrinemia

A 3-year-old girl with H. Pylori negative duodenal ulcer with hypergastrinemia secondary to chronic renal failure presenting with upper gastrointestinal bleed as the cardinal manifestation is unusual in toddlers and the case is presented for its rarity.     

普萘洛尔治疗婴儿型血管瘤溃疡

目的 总结普萘洛尔治疗婴儿型血管瘤溃疡的经验. 方法 2010年1月至2012年12月我们收治婴儿型血管瘤伴溃疡患儿40例,男21例,女19例.记录血管瘤溃疡的发病年龄、就诊年龄、血管瘤类型,部位,溃疡类型,普萘洛尔治疗后疗效及副作用. 结果 患儿平均就诊年龄（5.1±1.9）个月,溃疡发生平均年龄（4.3±2.1）个月.92.5％的患儿为草莓状血管瘤,溃疡好发于四肢和臀部,溃疡平均深度（2.8±1.3）mm.普萘洛尔治疗时间（3.1±0.4）周,短于治疗前溃疡平均持续时间（P=0.04）.仅1例于服药期间出现出血、低血糖,1例出现心率减慢,经纠治后好转.100％的家属认为普萘洛尔对加速溃疡愈合有效. 结论 普萘洛尔治疗婴儿型血管瘤伴溃疡安全有效,值得推广应用.