Peptic ulcer disease in children

In the etiology and pathogenesis of peptic ulcer disease in children, as adults, we attach particular importance to disorders of the nervous system that regulates the function of the gastrointestinal tract, and violations of the diet and nutrition. There are indications of the relationship of peptic ulcer disease in children with cystic fibrosis (see) and the lack of the body of vitamin B6.
Ulcer in children is mainly localized in the duodenum. The clinical picture is quite diverse: the pain is usually intense, persistent, long-term, determined in the epigastric region, sometimes in the right hypochondrium, enhanced by palpation. Frequent seasonal exacerbation. Typical empty stomach pain, fixed meals, and late night. Almost all kids are marked diarrhoea phenomenon (belching, heartburn, nausea, vomiting). Appetite is usually not broken, sometimes even increased. With long-term existence of peptic ulcer note pathological changes in the liver (increase, violations functional samples) and intestines (constipation). Peptic ulcer disease in children protracted and relapsing.
Peptic ulcer disease in children is often complicated by paraduodenal (inflammation of the serous membrane duodenal ulcer), minor bleeding that are discovered during the examination of stool for occult blood. Perforation ulcers (usually occurs in adolescence), severe bleeding from her and stenotic disease (narrowing) gatekeeper - more rare complications.
The diagnosis of peptic ulcer great importance should be given to patient complaints, especially his nervous system and family predisposition to this disease. The diagnosis is confirmed by x-ray studies.
Treatment. The disease onset or exacerbation prescribe bed rest for 3 weeks. Create conditions conducive to good emotional health of the child and physiological sleep. In the first 5-7 days appoint a diet 1-a and then 7-10 days - diet 1-6. In the future, use diet 1 for 4-6 months. In addition enter the vitamin b complex maximum age dosage, treatment with alkalis, mineral waters. Alkali (magnesium salts in combination with hydrogen carbonate sodium) are used for 1 hour before meals with high acidity, 30 min. before meals and before going to sleep at low or normal acidity of gastric juice. In the absence of occult blood in feces alkali can be replaced vikalin 72 pills 3 times a day after meals for 1 month; after a month-long course of treatment vikalin repeat. Pain assign extract of belladonna 0.001 g on 1 year of life, atropine 0.0001 g on 1 year of life per day, papaverine 0.01 g on 1 year of life per day, warmers, paraffin applications. The tendency to bleeding thermal treatments are contraindicated. For special reasons appoint antibiotics (penicillin and 300 000 - 400 000 IU a day for 8-10 days), etc. When bloody vomiting or intestinal bleeding - emergency hospitalization, rest, ice on his stomach, transfusion of blood and plasma (5 ml per 1 kg of weight), intravenous 3-5 ml of 10% solution of chloride calcium. At impossibility of blood transfusion subcutaneously injected 5-10 ml equine serum (Besedke), 3-5 ml of gamma globulin.
In the period of remission good therapeutic effect has a Spa treatment (Zheleznovodsk, Essentuki, Truskavets). During remission should be carried out 2 times a year (spring and autumn) short course anti-ulcer treatment includes bed rest, diet therapy, the use of alkalis or vikalin (1 / 2 tablets 3 times a day after meals for 1 month), vitamins, especially B1 and C, infusion of rose hips, cabbage juice, sedatives (bromine products, Valerian), etc.
Prevention of peptic ulcer disease in children is correct organization of nutrition, child rearing. Specific care must be children who received steroid hormones are undergoing severe nervous breakdown, as well as children whose relatives suffer from peptic ulcer disease.

Peptic ulcer disease is not so rare in children, as previously thought. Among children with disorders of the digestive system, according to clinicians, she is from 2.6 to 11.8%.
In the mechanism of occurrence of peptic ulcer disease in children of preschool and school age, the important fact is a violation of the regulatory mechanisms of the stomach from the nervous and endocrine systems. Essential and defects of the external environment.
The clinical picture of peptic ulcer disease in children and adults in many respects similar. In children ulcer more often localized in the duodenum, often raised acid-forming function of the stomach, rarely complications such as hemorrhage, perforation of ulcers; there is no clear prevalence incidence in male children.
Clinical symptoms of peptic ulcer disease in children is quite varied. Typical clinical picture is observed in more than half of the cases, in others there are forms with insufficient symptoms, especially in the initial period.
Acid-forming function of the stomach, most of the patients improved, often normal, lowering it is rare. Secretory function equally often elevated and normal, less often reduced, in some cases sharply and steadily increased.
Slow evacuation function is celebrated in almost half the cases, i.e. significantly more frequently than in children with other diseases of the stomach. The excitability of the receptor apparatus of the stomach and its regulatory mechanisms in most children, patients with peptic ulcer, dramatically strengthened.
Radiographically often detected picture of gastritis or gastroduodenitis, which sometimes precedes the identification of niches, there simultaneously with it persists after healing ulcers. Therefore, gastroduodenitis, radiographically detected in children with characteristic ulcer disease clinical picture, believe component, one of the signs of a stomach ulcer.
Often involved in the process liver (increase, tenderness, infringement of function) and the intestine (violation tonic and motor functions). Sometimes a violation of the functions of these bodies mistaken for the underlying disease, which is one of the reasons for the late detection of peptic ulcer.
Complications of peptic ulcer disease marked in 1/6 cases. Most often it is bleeding, then penetrating ulcers, stenosis piloroduodenalnoy region, perforation (mainly in young adulthood).
Peptic ulcer disease in children is often a protracted course, often remain in adulthood; in complicated ulcers sometimes have to resort to surgery, which is well tolerated even very emaciated children.
The correct diagnosis of the majority of children make a very late that explain a number of factors: underestimation of some forms of gastritis as the initial phase of peptic ulcer; insufficient and late examination of patients; underestimation of the values of secretory and motor function of the stomach; exceptional importance in the diagnosis of peptic ulcer data of x-ray examinations; weak knowledge clinics and peptic ulcer disease in children.
Treatment and prevention of peptic ulcer disease in children spend the same way as adults. The leading therapy is the impact on regulatory mechanisms and function of the stomach, including protective mode, mechanically and chemically light diet and medications. In cases of "fresh" ulcers and in the period of exacerbation prescribe bed rest for 2-3 weeks and create conditions conducive physiological sleep, good emotional state. In dietotherapy use tables therapeutic feeding 1 a and 1 b, 1, 1; and, for children, unlike adults, keep a diet 1 for a more gradual transition to less sparing diet and prescribed diet 1 for a longer period.
At the same time apply comprehensive treatment, including atropinization, treatment with alkalis or vikalin, multivitamin (with the exception of nicotinic acid), balsam of shestakovskoe or sea buckthorn oil, sedatives. In case of intolerance or lack of effectiveness of atropine appoint papaverine or platifillin, good painkiller is a no-Spa. In the absence of the effectiveness of the therapy and the presence of a sharp pain syndrome, hypersecretion of gastric shown ganglioblokatory (in stationary conditions, with caution). It is also shown blood transfusion 50-100 ml, 3-5 times at intervals of 3-5 days.
Spa treatment can be held in children's resorts of Zheleznovodsk, Truskavets, Yessentuki and other
However, good results can be achieved when treatment is not at the resort: in the hospital or home under medical supervision, while respecting the basic principles of treatment and preventive treatment courses 2 times a year. When this is prescribed shortened bed or pruposely mode, diets 1, 1 a or 1, alkalis or vikalin within 1 month, atropinization within two weeks (the latter excludes the assignment of vikalin), multivitamin, sedatives.
Complicated ulcers require the same measures as adults.