Eosinophilic gastroenteritis as a cause of non-Helicobacter pylori, non-gastrotoxic drug ulcers in children

Abstract

Background: While Helicobacter pylori (H. pylori) ulcers has declined recently, H. pylori-negative and/or gastrotoxic drug-negative peptic ulcers (HNGN-PU) has increased. This study aimed to analyze the etiology of peptic ulcers in children and the differences in clinical, laboratory, endoscopic, and histopathologic findings of peptic ulcers according to etiology, including eosinophilic gastroenteritis (EoGE). Methods: In total, 255 children (157 boys and 98 girls) with peptic ulcers were recruited. The subjects were categorized into 5 groups according to the etiology of the ulcer: 1) H. pylori infection (n = 51); 2) gastrotoxic drugs (n = 18); 3) idiopathic (n = 144); 4) systemic disease (n = 23); 5) EoGE (n = 19). Clinical data were reviewed and analyzed retrospectively. Results: Age at diagnosis, ulcer recurrence, atopic dermatitis history, white blood cell count, blood eosinophil count, platelet count, serum albumin level, iron level, erythrocyte sedimentation rate, and C-reactive protein level differed significantly among the 5 groups (all p < 0.05). Regarding endoscopic findings, multiple ulcers and gastric mucosal nodularity differed among the 5 groups (all p < 0.05). When comparing the EoGE ulcer group with the others, EoGE group revealed older ages (p = 0.022), higher rates of ulcer recurrence (p = 0.018), atopic dermatitis history (p = 0.001), and both blood and tissue eosinophilia (both p = 0.001). Conclusions: EoGE ulcers constituted 10.2% of HNGN-PU in pediatric patients. In children with HNGN-PU, peripheral eosinophilia, ulcer recurrence, and atopic dermatitis history might imply EoGE, necessitating thorough investigation of tissue eosinophils during endoscopic biopsy. Trial registration: A total of 255 children was retrospectively registered between between July 2003 and April 2017.

Pepti̇k Ülserli̇ Çocuk Hastalarin Değerlendi̇ri̇lmesi̇: Tek Merkez Deneyi̇mi̇

“…Today, the frequency of PUD, associated with non-Hp and non-NSAID risk factors, is increasing (1,7). In our study, the frequency of PUD associated with non-Hp and non-NSAID risk factors was found to be 12.5%.…”

“…Studies describing Hp-negative PUD in children are limited. However, an increasing number of studies that draw attention to Hp-negative and idiopathic PUD are repor-ted (7,9,11,12). For the definition of idiopathic PUD, possible risk factors for PUD should be excluded, drug use history should be questioned, and Hp should be excluded with at least two different diagnostic tests (30).…”

“…Gastric outlet obstruction is found in less than 5% of peptic ulcers (39). The number of studies reporting the frequency of GOO in childhood PUD is low (7,14). In our study, the frequency of GOO was found to be 2.2%, while Joo et al (7) reported a frequency of 1.6% and Ankouane et al ( 14) 13%.…”

“…The number of studies reporting the frequency of GOO in childhood PUD is low (7,14). In our study, the frequency of GOO was found to be 2.2%, while Joo et al (7) reported a frequency of 1.6% and Ankouane et al ( 14) 13%. In our cases, most of them had duodenal stenosis that resolved with medical treatment, and one case had GOO that improved after surgical dilation, and it was thought that it did not adversely affect the prognosis.…”

Phenotypes of Duodenal Ulcer in Children

“…Відкриття інфекції Helicobacter pylori, яка сприяє утворенню пептичних виразок, призвело до переоцінки традиційного підходу до діагностики та лікування болю в животі у дітей [8][9][10][11][12][13]. Незважаючи на те, що інфекція Helicobacter pylori поширена в усьому світі, останні дані засвідчують про переважання Helicobacter pylori-неасоційованої виразки дванадцятипалої кишки у дорослих [14,15]. Приблизне співвідношення Helicobacter pylori-асоційованих та Helicobacter pylori-неасоційованих виразок у дітей невідоме.…”