Peptic ulcers, gastritis, and duodenitis (pediatrics): Clinical sciences

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Peptic ulcers, gastritis, and duodenitis belong to a spectrum of conditions known as acid peptic disease. These conditions are characterized by excessive gastric acid production and weakened gastric or duodenal mucosa, which lead to superficial inflammation and erosions known as gastritis or duodenitis. When damage progresses deeper and invades the muscularis mucosa layer, a peptic ulcer forms. Treatment of acid peptic disease depends on the presence or absence of a coexisting Helicobacter pylori infection.

Now, if a pediatric patient presents with a chief concern suggesting a peptic ulcer, gastritis, or duodenitis, first perform an ABCDE assessment to determine if they are stable or unstable. If unstable, stabilize their airway, breathing, and circulation. Next, obtain IV access and consider administering IV fluids or a transfusion of packed red blood cells. Put your patient on continuous vital sign monitoring, including blood pressure, heart rate, and pulse oximetry; and provide supplemental oxygen if needed. Consider placing a nasogastric tube, with or without nasogastric lavage. Also, if the patient has active bleeding or hypotension, obtain an emergent esophagogastroduodenoscopy, or EGD. Finally, consider an infusion of proton pump inhibitor or vasopressin.

Here’s your first clinical pearl! Peptic ulcers, gastritis, and duodenitis can be complicated by bleeding, in the form of hematemesis or melena, as well as gastrointestinal perforation, stricture, and obstruction. Ulcers that cause heavy or brisk bleeding may require emergent intervention, such as coagulation therapy or vasopressor support.

Sources

  1. "Joint ESPGHAN/NASPGHAN Guidelines for the Management of Helicobacter pylori in Children and Adolescents (Update 2016)" J Pediatr Gastroenterol Nutr (2017)
  2. "Nelson Textbook of Pediatrics, 21st ed. " Elsevier (2020)
  3. "Pediatric Gastritis, Gastropathy, and Peptic Ulcer Disease" Pediatr Rev (2018)