Gastroduodenal ulcers in the Helicobacter pylori era

The aim of the study was to evaluate the current spectrum of gastroduodenal ulcers in children referred to a regional paediatric unit in the United Ki ngdom. During a 5-y period (1994-98), all children with a visibly discrete gastric and/or duodenal ulcer diagnosed at endoscopy were prospectively ide ntified. Patients with ulcers associated with Helicobacter pylori gastritis underwent repeat endoscopy 2-3 mo after medical treatment. Thirty-seven ch ildren, 21 boys and 16 girls of median age 11 y (range 7 mo to 16 y), had g astric and/or duodenal ulceration. Specific aetiological factors were ident ified in 21 of 22 with H. pylori negative ulcers, including Crohn's disease (n=6), coeliac disease (n=4) and treatment with ulcerogenic drugs (n=4). F ifteen children (41%) had ulcers associated with H. pylori gastritis, inclu ding all 10 children with a chronic ulcer. Endoscopically confirmed ulcer h ealing was achieved in 14 of these using a 1 wk triple therapy regimen (ome prazole and a combination of two antibiotics). In conclusion, the recognized spectrum and the management of gastroduodenal ulceration have changed during the last decade. Although H. pylori gastrit is is an important aetiological factor, a wide range of other conditions ne eds to be considered. Surgical intervention is only rarely necessary.