Peptic ulcer disease in children. Diagnosis, treatment, and the implication of Helicobacter pylori.

Peptic ulcers are a relatively infrequent occurrence in children. Ulcers in the stomach and duodenum are typically secondary to systemic illnesses or drugs in young children; secondary ulcers do not recur. In contrast, duodenal ulcers in older children and adolescents have a relapsing course that is increasingly recognized to be related to coexisting, chronic, active antral gastritis and Helicobacter pylori infection. Antihelicobacter therapy not only heals duodenal ulcers, but it alters the natural history by reducing the frequency of ulcer recurrences. Not all primary duodenal or gastric ulcers in the pediatric population, however, are related to H. pylori; their cause remains unknown. Treatment for these patients requires either antacids, H2 blockers, proton pump inhibitors, or ulcer coating agents for 6-8 weeks along with long-term maintenance therapy.