Pediatric Gastritis, Gastropathy, and Peptic Ulcer Disease

Desiree Sierra; Mary Wood; Sneha Kolli; Lina Maria Felipez

doi:10.1542/pir.2017-0234

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Desiree Sierra, MD*
Mary Wood, MD*
Sneha Kolli, MD*
Lina Maria Felipez, MD^†

^*Department of Medical Education and
^†Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Nicklaus Children’s Hospital, Miami, FL

AUTHOR DISCLOSURE
Drs Sierra, Wood, Kolli, and Felipez have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Abbreviations:

H2RA:: histamine 2 receptor antagonist
IBD:: inflammatory bowel disease
NSAID:: nonsteroidal anti-inflammatory drug
PPI:: proton pump inhibitor
PUD:: peptic ulcer disease

Education Gap

Providers should be able to identify the signs and symptoms of peptic ulcer disease in children, select the proper diagnostic tests needed to confirm the diagnosis, and describe adequate treatment regimens to start once the diagnosis is confirmed.

Objectives

After completing this article, readers should be able to:

Understand the mechanism and pathogenesis of gastritis, gastropathy, and peptic ulcer formation.
Recognize the symptoms of and risk factors for gastritis, gastropathy, and peptic ulcer disease.
Understand which patients warrant referral to a gastroenterologist for possible endoscopy.
Review the role of Helicobacter pylori in peptic ulcer disease.
Review the treatment of peptic ulcer disease with and without the presence of H pylori.

Introduction

Gastritis, gastropathy, and peptic ulcer disease (PUD), collectively known as acid peptic disease, are often described as a spectrum of the same disease. Although these conditions are more common in adults, their incidence in the pediatric population is clinically significant. Left untreated, gastritis can progress to PUD, which can result in serious complications such as perforation, bleeding, bowel strictures, and obstruction. Studies describing the role of Helicobacter pylori, nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and other causes have helped to further expand our understanding of gastritis and PUD in children. Direct visualization and the ability to biopsy with endoscopy have revolutionized the diagnosis and treatment of these diseases.

Epidemiology

The incidence of PUD in children is lower than that in adults. Based on several international studies, the incidence in children varies from 2% to 8%. (1)(2) The incidence of bleeding ulcers is lower and is estimated to be between 0.5 and 4.4 of 100,000 individuals. (3) These rates …