Abstract:
Objective
To study the clinical characteristics and endoscopic features of peptic ulcer in 320 children.
Methods
A total of 4 541 children with digestive tract symptoms underwent electrogastroscopy in Shenzhen Children's Hospital from January 2014 to January 2017; 320 of them were diagnosed with peptic ulcer, 254 boys and 66 girls. Their age ranged from one to 14 years old, among whom 29 were under 3, 75 between 3 and 6, 162 between 6 and 12, and 54 aged 12 to 14 years. There were 218 cases of duodenal ulcer, 78 cases of gastric ulcer, and 24 cases of other ulcer. Totally 207 cases were H. pylori-positive and 113 were negative. The ulcer area was less than 1 cm in 143 cases, 1 to 2 cm in 145 cases, and >2 cm in 32 cases. The ulcer was complicated with hemorrhage in 107 cases, with pyloric obstruction in 33 cases, and with perforation in one case. The following items were analyzed in the children at different ages: the incidence of ulcer, the gender difference, the site of disease, the area and the situation of H. pylori infection.
Results
(1) The incidence rate in the children of school age(>6 to 12 years) was the highest(80.2%,130/162); duodenal ulcer occurred mainly in school-age children; gastric ulcer occurred mainly in preschool children. There was statistical difference in the incidence of peptic ulcer among children of different ages(P<0.05).(2)The ratio of boys to girls in children with peptic ulcer was 3.85∶1, which was 3.19∶1 in duodenal ulcer and 5∶1 in gastric ulcer. The incidence rate in boys was significantly higher than that in girls in the children with peptic ulcer(P<0.05).(3)The detection rate of H. pylori in children with peptic ulcer was the highest(64.7%,207/320), which was different in different types of peptic ulcer. The detection rate of H. pylori was the highest in children with duodenal ulcer(74.3%,162/218); there was statistical difference in the rate in different types of peptic ulcer(P<0.05).(4)There was statistical difference in the rate of H. pylori infection in the children of different ages with peptic ulcer(P<0.05).(5)The ulcer area in childhood peptic ulcer was mostly less than 2 cm, which was obviously larger in H. pyloripositive children than in H. pylorinegative ones, the difference being statistical(P<0.05).(6)The rate of complications in children with peptic ulcer was significantly increased; the incidence rate of hemorrhage and pyloric obstruction had statistical difference compared with H. pylorinegative children(P<0.05).(7)Duodenal ulcer tended to occur on the front wall, followed by the greater curvature; gastric ulcer was more likely to occur in gastric antrum followed by gastric angle.
Conclusion
Most of peptic ulcer in children is duodenal ulcer. Age and gender are obviously related to its incidence, which is the highest in schoolage and preschool children, and higher in boys than in girls. Peptic ulcer is closely related to H. pylori, which is one of the main causes of peptic ulcer in children. Clinically for the children with digestive tract hemorrhage or with anemia of unknown cause, electrogastroscopy should be performed to exclude peptic ulcer so as to reduce missed diagnosis and misdiagnosis.

Key words: Peptic ulcer, Gastroscopy, Helicobacter pylori, Child