Diagnostic Utility of Ultrasonography for Duodenal Ulcers in Pediatric Cases in Japan

Abstract

Objective: To evaluate the diagnostic utility of wall hypertrophy of the duodenal bulb with a hyperechoic lumen, designated as the "HH sign," using ultrasound sonography (US) in pediatric duodenal ulcer (DU) patients. Study design:We performed a US for five pediatric subjects diagnosed with DU by upper gastroscopy to determine the presence of the potentially diagnostic HH sign. The sonographic images were analyzed before and after DU treatment. Computed tomography was performed in three cases and fecal occult blood test (FOBT) in all five cases.Results: Upper gastroscopy confirmed DU in all patients. While the HH sign was observed using US in four cases, with the DU located in the anterior bulb, the FOBT was positive in only one case. In these four cases, the HH sign diminished in response to treatment, as visualized by US. This was observed for both the initial as well as recurrent episodes. A mass-like region was observed in only one case, with the ulcer located in the proximity of the inferior duodenal wall. Conclusion:The HH sign is useful for the follow-up of DU, and US may be a suitable modality for the follow-up. We believe that this diagnostic marker can aid in following up a greater number of DU cases.

Diagnostic Accuracy of Ultrasound for Detecting Gastric or Duodenal Ulcers in Pediatric Patients

“…Patients with gastric or duodenal ulcers presented various symptoms, including abdominal pain, vomiting, hematemesis, anemia, bleeding, nausea, weight loss, or poor feeding. [1][2][3]6,13 Therefore, we included pediatric patients who presented with the above clinical signs and underwent ultrasound and gastroduodenal endoscopy or surgical intervention for perforation. We excluded patients who underwent pre-ultrasound endoscopy or those with an interval between ultrasound and endoscopy of >4 weeks.…”

“…G astric and duodenal ulcers are rare among pediatric patients; however, they require urgent interventions to prevent complications, such as hemorrhagic shock or gastroduodenal perforation. [1][2][3] Although endoscopic examination is needed to diagnose gastroduodenal ulcers, [4][5][6] this examination is difficult in pediatric patients given the need for sedation or general anesthesia and other technical difficulties. 1,2,6 Ultrasound is usually the first modality for evaluating pediatric patients with abdominal symptoms given its utility and lack of radiation.…”

“…[1][2][3] Although endoscopic examination is needed to diagnose gastroduodenal ulcers, [4][5][6] this examination is difficult in pediatric patients given the need for sedation or general anesthesia and other technical difficulties. 1,2,6 Ultrasound is usually the first modality for evaluating pediatric patients with abdominal symptoms given its utility and lack of radiation. 7,8 If the ultrasound showed imaging findings suggestive of gastroduodenal ulcer, examiners rapidly recommended invasive examination, such as endoscopy.…”