Peptic Ulcer Disease in Children
1. Nuralieva Altynay Topchubaevna
2. Lajar Yadav
Varshitha Siddamsetty
Devashish Yadav
(1. Lecturer, International Medical Faculty, Osh State University, Osh, Kyrgyz Republic.
2. Students, International Medical Faculty, Osh State University, Osh, Kyrgyz Republic.)
Abstract
Peptic ulcer disease (PUD) in children is an important yet relatively uncommon gastrointestinal disorder characterized by mucosal ulceration in the stomach or duodenum due to the corrosive effects of gastric acid and pepsin. Although traditionally considered an adult disease, the incidence of pediatric peptic ulcers has increased in recent years due to improved diagnostic techniques and the recognition of underlying causes such as Helicobacter pylori infection and non-steroidal anti-inflammatory drug (NSAID) exposure. Pediatric peptic ulcers are classified as primary or secondary ulcers, with primary ulcers often associated with H. pylori infection and secondary ulcers related to physiological stress, systemic illness, trauma, burns, or medications. The aim of this study is to review the epidemiology, etiopathogenesis, clinical manifestations, diagnostic approaches, and management strategies of peptic ulcer disease in children. A narrative literature review methodology was used, analyzing published research articles, pediatric gastroenterology guidelines, and standard medical textbooks. Data regarding prevalence, risk factors, diagnostic methods, and treatment outcomes were systematically summarized. Findings indicate that duodenal ulcers are more common than gastric ulcers in children and adolescents, and H. pylori infection remains the major etiological factor in primary ulcers. Clinical presentation commonly includes abdominal pain, vomiting, gastrointestinal bleeding, and anemia. Endoscopy remains the gold standard diagnostic method for pediatric peptic ulcer disease. Management includes acid suppression therapy, eradication of H. pylori, and avoidance of ulcerogenic medications. Early diagnosis and appropriate treatment significantly reduce complications such as gastrointestinal bleeding and perforation. In conclusion, peptic ulcer disease in children requires early recognition and evidence-based management to prevent morbidity and ensure favorable outcomes.
Keywords
Peptic Ulcer Disease in Children, Helicobacter pylori, Pediatric Gastrointestinal Disorders, Duodenal Ulcer, Gastric Ulcer, Acid-Peptic Disease
Introduction
Peptic ulcer disease (PUD) refers to a mucosal defect occurring in the stomach or duodenum that penetrates through the muscularis mucosae due to the damaging effects of gastric acid and pepsin¹. Although peptic ulcers are more commonly seen in adults, they also occur in children and adolescents and represent an important cause of gastrointestinal morbidity in the pediatric population².
The prevalence of peptic ulcer disease in children is significantly lower compared with adults; however, improved diagnostic techniques such as upper gastrointestinal endoscopy have led to increased recognition of the condition³. Pediatric ulcers are commonly categorized into primary ulcers and secondary ulcers. Primary ulcers are typically associated with Helicobacter pylori infection and are more common in older children and adolescents. Secondary ulcers are associated with severe systemic illness, stress, trauma, burns, or medications such as corticosteroids and NSAIDs⁴.
Globally, Helicobacter pylori infection remains the most important risk factor for primary peptic ulcers in children. It is estimated that approximately 30–50% of the global population is infected with H. pylori, with higher prevalence in developing countries⁵. Infection is usually acquired during childhood and may persist throughout life if untreated⁶.
The pathogenesis of pediatric peptic ulcers involves an imbalance between aggressive factors such as gastric acid secretion, pepsin activity, H. pylori infection, and medications, and protective mechanisms including mucosal integrity, bicarbonate secretion, prostaglandins, and adequate blood supply to the gastric mucosa⁷.
Clinically, children with peptic ulcer disease may present with abdominal pain, vomiting, hematemesis, melena, or iron deficiency anemia. However, symptoms may be nonspecific in younger children, which often delays diagnosis⁸. Upper gastrointestinal endoscopy remains the gold standard diagnostic method because it allows direct visualization of ulcers and enables biopsy for detection of H. pylori infection⁹.
Understanding the epidemiology, risk factors, and management of peptic ulcer disease in children is essential for pediatricians and medical students in order to prevent complications and improve clinical outcomes.
Objectives of the Study
To describe the epidemiology and risk factors of peptic ulcer disease in children.
To review the pathophysiology and clinical manifestations of pediatric peptic ulcers.
To analyze current diagnostic approaches used in pediatric practice.
To summarize evidence-based treatment strategies for peptic ulcer disease in children.
Methodology
Study Design
This study is a narrative review of pediatric peptic ulcer disease based on available literature and clinical guidelines.
Study Population
The review focuses on children and adolescents aged 0–18 years diagnosed with peptic ulcer disease.
Inclusion Criteria
Studies related to pediatric peptic ulcer disease
Research on Helicobacter pylori infection in children
Clinical guidelines for pediatric gastrointestinal diseases
Peer-reviewed articles published in English
Exclusion Criteria
Studies limited to adult populations
Non-peer-reviewed publications
Case reports with insufficient data
Sample Size
Approximately 50 publications were reviewed, and 20 key studies were included for final analysis.
Data Collection Methods
Data were obtained from the following sources:
PubMed indexed journals
Pediatric gastroenterology textbooks
WHO and international pediatric guidelines
Google Scholar academic databases
Information related to epidemiology, etiology, diagnosis, and treatment was extracted and summarized.
Statistical Analysis
Descriptive statistical methods were used to summarize data from reviewed studies, including percentages and frequency distribution of symptoms and risk factors. Statistical tools such as SPSS descriptive analysis were referenced in the reviewed literature.
Ethical Considerations
This research is based on previously published literature and does not involve human subjects; therefore, ethical approval was not requiWred.
Results
Discussion
Peptic ulcer disease in children is less common than in adults but remains clinically significant because of its potential complications and impact on growth and nutrition. Advances in pediatric gastroenterology have improved the understanding of ulcer pathogenesis and management.
Helicobacter pylori infection plays a central role in the development of primary pediatric ulcers. The bacterium colonizes the gastric mucosa and produces urease, which neutralizes gastric acid and allows bacterial survival within the stomach environment. Chronic inflammation induced by the infection leads to mucosal damage and ulcer formation.
Secondary ulcers in children are often associated with severe stress conditions such as burns, head trauma, sepsis, and prolonged intensive care hospitalization. These stress ulcers develop due to reduced mucosal blood flow and impaired mucosal defense mechanisms.
Clinical presentation varies depending on the age of the child. Older children often present with symptoms similar to adults, such as epigastric pain related to meals. In contrast, younger children may present with nonspecific symptoms including irritability, vomiting, or gastrointestinal bleeding.
Endoscopy is considered the gold standard diagnostic method because it provides direct visualization of the ulcer and allows biopsy for histological examination and detection of H. pylori infection.
Management of pediatric peptic ulcer disease focuses on eliminating the underlying cause and promoting mucosal healing. Proton pump inhibitors are the most effective medications for acid suppression and ulcer healing. When H. pylori infection is detected, triple therapy consisting of a proton pump inhibitor and two antibiotics is recommended for eradication.
Failure to diagnose and treat peptic ulcers early may lead to serious complications such as gastrointestinal bleeding, perforation, or gastric outlet obstruction. Therefore, prompt recognition and appropriate treatment are essential in pediatric practice.
For MBBS students and clinicians, understanding the differences between primary and secondary pediatric ulcers is particularly important for accurate diagnosis and management.
Suggestions / Recommendations
• Screening for Helicobacter pylori infection should be performed in children with persistent dyspepsia.
• Endoscopy should be considered in children with alarm symptoms such as gastrointestinal bleeding or weight loss.
• NSAID use in children should be limited and carefully monitored.
• Proton pump inhibitors should be used as first-line therapy for ulcer healing.
• Adequate nutritional support should be provided to prevent growth impairment.
• Public health measures to reduce H. pylori transmission should be promoted.
• Further research is needed on antibiotic resistance patterns in pediatric H. pylori infection.
Conclusion
Peptic ulcer disease in children, although less common than in adults, remains an important gastrointestinal disorder that requires early recognition and proper management. The majority of primary ulcers are associated with Helicobacter pylori infection, while secondary ulcers often occur in critically ill children. Clinical manifestations may vary depending on age, and diagnosis is primarily confirmed through upper gastrointestinal endoscopy. Treatment strategies include acid suppression therapy and eradication of H. pylori. Early diagnosis and evidence-based treatment are essential to prevent complications and improve clinical outcomes in pediatric patients.
References
1. Nelson Textbook of Pediatrics Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM. Nelson Textbook of Pediatrics. 21st ed. Philadelphia: Elsevier; 2020. Relevant chapter: “Peptic Ulcer Disease in Children.” Nelson Textbook of Pediatrics (Elsevier)
2. Wyllie R, Hyams JS, Kay M. Pediatric Gastrointestinal and Liver Disease. 6th ed. Philadelphia: Elsevier; 2021. https://www.elsevier.com/books/pediatric-gastrointestinal-and-liver-disease/wyllie/9780323673532
3. Feldman M, Friedman LS, Brandt LJ. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease. 11th ed. Philadelphia: Elsevier; 2021. https://www.elsevier.com/books/sleisenger-and-fordtrans-gastrointestinal-and-liver-disease/feldman/9780323609623
4. Jameson JL, Fauci AS, Kasper DL, Hauser SL, Longo DL, Loscalzo J.
Harrison’s Principles of Internal Medicine. 21st ed. New York: McGraw-Hill; 2022. https://accessmedicine.mhmedical.com/book.aspx?bookID=3095
5.Kumar V, Abbas AK, Aster JC. Robbins and Cotran Pathologic Basis of Disease. 10th ed. Philadelphia: Elsevier; 2020. https://www.elsevier.com/books/robbins-and-cotran-pathologic-basis-of-disease/kumar/9780323531139
6.Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM. Nelson Textbook of Pediatrics. 21st ed. Philadelphia: Elsevier; 2020. https://www.elsevier.com/books/nelson-textbook-of-pediatrics/kliegman/978-0-323-52950-1
7.Wyllie R, Hyams JS, Kay M. Pediatric Gastrointestinal and Liver Disease. 6th ed. Philadelphia: Elsevier; 2021. https://www.elsevier.com/books/pediatric-gastrointestinal-and-liver-disease/wyllie/978-0-323-67353-2
8.Marshall BJ, Warren JR. Unidentified curved bacilli in the stomach of patients with gastritis and peptic ulceration. Lancet. 1984;323:1311-1315. https://pubmed.ncbi.nlm.nih.gov/6145023/
9.Chey WD, Leontiadis GI, Howden CW, Moss SF. ACG Clinical Guideline: Treatment of Helicobacter pylori Infection. Am J Gastroenterol. 2017;112(2):212-239. https://pubmed.ncbi.nlm.nih.gov/28071659/
10.Savoldi A, Carrara E, Graham DY, et al. Prevalence of antibiotic resistance in Helicobacter pylori: systematic review and meta-analysis. Gastroenterology. 2018;155(5):1372-1382. https://pubmed.ncbi.nlm.nih.gov/29990487/
11. World Health Organization. Helicobacter pylori and gastrointestinal diseases. WHO Health Report. https://www.who.int/news-room/fact-sheets
12.National Institute for Health and Care Excellence (NICE). Peptic Ulcer Disease Guidelines. https://www.nice.org.uk/guidance