Aspectos clínicos e histológicos da úlcera duodenal em crianças e adolescentes

Abstract

Objective: To evaluate clinical and histological features of duodenal ulcer in children and adolescents.Methods: Forty-three children with duodenal ulcer were prospectively and consecutively evaluated in a 6 year period (7.2 patients per year). Evaluation included clinical questionnaire focused on dyspeptic symptoms, physical examination, and digestive endoscopy with gastric biopsies for histological examination and Helicobacter pylori detection.Results: Diagnostic age ranged from 4 years and 8 months to 17 years and 4 months (mean age: 12 years and 4 months). Abdominal pain was the main symptom (39/43, 90.7%), which was epigastric in 31/39, periumbilical in 7/39, and nocturnal in 27/39. Other symptoms were loss of appetite (32/ 8%).Helicobacter pylori infection was detected in 41/43 (95.3%). All infected patients presented acute chronic gastritis in antrum, with lymphomononuclear infiltrate predominance in 92% of them. Eradication of the bacterium occurred in 68.3%. Ulcer healing occurred in all eradicated patients and in 89% of non-eradicated patients.Conclusion: Duodenal ulcer was associated with chronic gastritis due to Helicobacter pylori in the majority of patients. Many complications occurred, especially upper digestive bleeding.

Sickle cell anemia with perforated duodenal ulcer as a complication: when to suspect this rare entity?

“…It is estimated that the prevalence of the disease in large pediatric centers is 4 to 7 new cases per year [3] . Data from our pediatric service at the Escola Paulista de Medicina of the Universidade Federal of São Paulo reported by Kawakami et al [4] showed that there were 7.2 diagnoses and/or year.…”

Gastroduodenal peptic ulcer and Helicobacter pylori infection in children and adolescents

“…Grandes centros médicos de pediatria na América do Norte diagnosticam uma média de quatro a seis casos novos por ano 15,16 . No Serviço de Gastroenterologia Pediátrica do Hospital das Clínicas da Universidade Federal de Minas Gerais, a média anual é de 7,6 novos casos por ano 17 , muito semelhante à observada na Universidade Federal de São Paulo/Escola Paulista de Medicina (7,2 pacientes por ano) 18 . Quanto ao sexo, alguns estudos mostram que a doença acomete mais freqüentemente os meninos 16,18 .…”

“…Alguns autores relatam que o aspecto mais consistente da dor na UP da criança é sua variabilidade 75 . Em um estudo realizado no Brasil, avaliando 43 crianças e adolescentes de 4 a 17 anos, os autores demonstraram que a dor abdominal estava presente em 90,7% dos casos 18 ; localizava-se com mais freqüência no epigástrio (79,5%); em 56,4% das crianças, sob a forma de queimação; em 51,3%, melhorava com a ingestão de alimentos; hiporexia (74,4%) e vômitos (69,8%) foram os sintomas mais comumente associados à dor 18 . Outros sintomas, como pirose, sialorréia, sensação de plenitude, anorexia, perda de peso, distensão abdominal, eructação, meteorismo e anemia ferropriva ocorrem mais raramente 17,76 .…”

Úlcera péptica gastroduodenal e infecção pelo Helicobacter pylori na criança e adolescente

“…18 Some studies have shown a male predominance for this disease. 16,18 As previously mentioned, H. pylori is a crucial factor in the pathogenesis of PU. Most children with duodenal PU test positive for the bacterium.…”