A 45-YEAR EXPERIENCE WITH SURGICAL-TREATMENT OF PEPTIC-ULCER DISEASE IN CHILDREN

Peptic ulcer disease (PUD) requiring surgical treatment has become rar e with the availability of modern medical management. A retrospective study of all patients who required operations for PUD between 1949 and 1994 (n = 43) was done. The patients were classified into 3 groups: A (n = 38): pre-histamine-2 (H2) blocker era (1949-1975); B (n = 3): pr e-hydrogen-potassium (H-K+) ATPase inhibitor era (1976-1988); C (n = 2 ): H-K+ ATPase inhibitor era (1989-1994). Data, analyzed using chi(2) analysis (P < .01), included preoperative medical therapy, surgical in dications, type of operation performed, complications, and postoperati ve medical therapy. The indication for surgery in group A was bleeding (26), perforation (8), or obstruction (4); in group B the indication was obstruction (2) or perforation (1); in group C the indication was obstruction (1) or bleeding (1), The incidence of obstruction as an in dication for surgery did not differ among the groups (P < .01). Two of the three patients who had surgery for obstruction in groups B and C had biopsy-proven Helicobacter pylori. The postoperative morbidity rat e was lower for groups B and C, although not significantly. The relati ve mortality among the groups did not change (P > .01). Children with PUD can have complications similar to those of adults with PUD. Since the introduction of H2 antagonists, the recognition and treatment of H pylori, and the use of H-K+ ATPase inhibition, the incidence of opera tions for bleeding and perforation has decreased dramatically. However , the incidence of surgery for obstruction remains the same. Copyright (C) 1996 by W.B. Saunders Company