%0 Journal Article
%T Update on Peptic Ulcers in the Pediatric Age
%A Graziella Guariso
%A Marco Gasparetto
%J Ulcers
%D 2012
%I Hindawi Publishing Corporation
%R 10.1155/2012/896509
%X Background. Peptic ulcer disease (PUD) in children is reported worldwide, although it is relatively rare as compared with adults. Helicobacter pylori (HP) infection is a common cause of PUD in the pediatric age. Other risk factors include the use of nonsteroidal anti-inflammatory agents (NSAIDs), steroids, immunosuppressive drugs, and stressful events. Aim. To critically review the evidence on epidemiology, diagnostic management, and available treatments for PUD in the pediatric age. Methods. A MEDLINE search was performed indicating keywords as ¡°Peptic Ulcer Disease,¡± ¡°Epidemiology,¡± ¡°Pediatric,¡± ¡°Helicobacter pylori,¡± ¡°Gastric ulcer,¡± ¡°Bulbar Ulcer,¡± and ¡°Upper Gastrointestinal Bleeding.¡± A selection of clinical trials, systematic reviews, and meta-analyses within the time period 2002¨C2012 was performed. Results. PUD in children is reported worldwide with an estimated frequency of 8.1% in Europe and of 17.4% in the US. When the underlying cause of PUD is addressed, the prognosis is excellent. Standard triple therapy, bismuth-based quadruple therapy, and the sequential therapy represent the current recommended treatments for HP related ulcers. NSAIDs related ulcers are treated by stopping the causative medications and by administration of proton-pump inhibitors or antisecretory drugs. Conclusions. PUD still represents a major concern in the paediatric age. A careful differential diagnosis and an adequate treatment constitute an excellent prognosis. 1. Introduction Peptic ulcers are discontinuities of the gastric or duodenal mucosa with penetration to the muscularis mucosae and exposure of the submucosa [1, 2]. Primitive ulcers are caused by alterations of the gastric function (i.e., increased HCl production and pepsin function); they are mainly single lesions and are usually found at the small gastric curve and at the antrum. Secondary ulcers, on the contrary, are caused by extragastric pathogenic events, that is, stress or drugs. They can be multiple and can have a spread localization within the stomach. More than 20% of patients have a family history of duodenal ulcers. In up to one third of patients with duodenal ulcers, basal acid output (BAO) and maximal acid output are increased. A study by Schubert and Peura [3] attested that individuals are at especially high risk those with a basal acid production (BAP) greater than 15£¿mEq/h. In addition to the increased gastric and duodenal acidity observed in some patients with duodenal ulcers, accelerated gastric emptying is also often present. A common cause of peptic ulcers in the pediatric age is
%U http://www.hindawi.com/journals/ulcers/2012/896509/