Çocuklarda peptik ülser hastalığı

Öz

Amaç Çocukluk çağında peptik ülserlere ilişkin veriler yetersizdir. Bu çalışmanın amacı, çocuklarda peptik ülser hastalığı (PÜH) sıklığını ve özelliklerini saptamak, H.pylori ile diğer nedenlere bağlı PÜH’ nı karşılaştırmaktır. 

Yöntem Haziran 2008 ile Haziran 2019 tarihleri arasında endoskopi yapılan pediatrik hastalar incelendi. PÜH olan her hasta için yaş, cinsiyet, klinik bulgular, peptik ülserin (PÜ) yeri, histopatolojik olarak H.pylori varlığı ve hemoglobin değerleri kaydedildi. Hastalar H.pylori’ ye bağlı ve diğer nedenlere bağlı PÜH olarak ikiye ayrıldı. İki grup karşılaştırıldı.

Bulgular 6216 hastanın 60’ına (% 0.98) PÜH tanısı konuldu. Altmış hastanın yaş ortalaması 10.59±4.89 yıl olup, 32 (%53.3)’ i erkek, 28 (%46.6)’ i kızdı. En sık şikâyet karın ağrısıydı (n=40; %60.6). Altmış hastanın 12 (%20)’ sinde histopatolojik olarak H.pylori tespit edildi. İki grup arasında yaş, cinsiyet, klinik bulgular, anemi veya PÜ’in yeri açısından fark yoktu.

Sonuç Peptik ülser hastalığı çocuk çağında nadir görülür. H.pylori ve diğer nedenlere bağlı PÜH arasında klinik bulgular, anemi ve PÜ’ in yeri açısından fark yoktur. İki grubun ayrımı için tüm hastalardan biyopsi alınmalıdır.

Anahtar Kelimeler

• peptik ülser,çocuklar,H.pylöri

Peptic ulcer disease in children

Öz

Background Data on peptic ulcers in childhood are insufficient. The aim of this study is to define the frequency and characteristics of peptic ulcer disease (PUD) in children and to compare with PUD due to H.pylori infection and the others.

Methods Pediatric patients that underwent upper gastrointestinal endoscopy between July 2008 and July 2019 were examined. Age, gender, clinical presentation, location of peptic ulcer (PU), presence of H.pylori histopathologically and hemoglobine values were recorded for each paient with PUD from the hospital file records. Patients were divided into two groups as patients with PUD associated H.pylori and patients with PUD associated with other etiologies. Then two groups were compared.

Results Sixty (0.98%) of 6216 patients were diagnosed with PUD. Sixty patients comprised 32 (53.3%) male and 28 (46.6%) female with a mean age of 10.59±4.89 years. The most common complaint was abdominal pain (n=40; %60.6). H.pylori was detected in 12 (20%) of 60 patients histopathologically. There was no difference between two groups for age, gender, clinical presentation, anemia or location of PU.

Conclusion PUD is a rare disorder in childhood. There is no difference between H.pylori related PUD and the others for clinical presentation, anemia or location of PU. For the discrimination of two groups, biopsy should be taken in all patients.

Anahtar Kelimeler

• peptic ulcer,children,H.pylori

Kaynakça

1. 1. Lin KJ, Garcia Rodraguez LA, Hernandez-Diaz S. Systematic review of peptic ulcer disease incidence rates: do studies without validation provide reliable estimates? Pharmacoepidemiol Drug Saf 2011;20:718-28.
2. 2. Sherman P, Czinn S, Drumm B, et al. Helicobacter pylori infection in children and adolescents: working group report of the first world congress of pediatric gastroenterology, hepatology, and nutrition.J Pediatr Gastroenterol Nutr 2002;35:128-33.
3. 3. Huang SC, Sheu BS, Lee SC, Yang HB, Yang YJ. Etiology and treatment of childhood peptic ulcer disease in Taiwan: a single center 9-year experience. J Formos Med Assoc 2010;109:75-81.
4. 4. Lanas A, Chan FKL. Peptic ulcer disease. Lancet 2017;390:613-24.
5. 5. Darko R, Yawson AE, Osei V, et al. Changing patterns of the prevalence of helicobacter pylori among patients at a corporate hospital in Ghana. Ghana Med J 2015;49:147-53.
6. 6. Kopacova M, Bures J, Koupil I, et al. Body indices and basic vital signs in Helicobacter pylori positive and negative persons. Eur J Epidemiol 2007;22:67-75.
7. 7. Figueiredo C, Machado JC, Pharoah P, et al. Helicobacter pylori and interleukin 1 genotyping: an opportunity to identify high-risk individuals for gastric carcinoma. J Natl Cancer Inst 2002;94:1680-7.
8. 8. Suerbaum S, Michetti P. Helicobacter pylori infection. N Engl J Med 2002;347:1175-86.

9. 9. Brugnara C, Oski FA, Nathan DG. Diagnostic approach to the anemic patient. In: Nathan and Oski’s hematology and oncology of infancy and childhood, 8th ed, Orkin SH, Fisher DE, Ginsburg D, et al (Eds), WB Saunders, Philadelphia 2015;293.
10. 10. Roma E, Kafritsa Y, Panayiotou J, et al. Is peptic ulcer a common cause of upper gastrointestinal symptoms? Eur J Pediatr 2001;160:497-500.
11. 11. Ecevit CO, Ozgenc F, Yuksekkaya HA, et al. Peptic ulcer disease in children: an uncommon disorder with subtle symptomatology. Turk J Gastroenterol 2012;23:666-9.
12. 12. Mitchell HM, Bohane TD, Tobias V, et al. Helicobacter pylori infection in children: potential clues to pathogenesis. J Pediatr Gastroenterol Nutr 1993;16:120-5.
13. 13. El Mouzan MI, Abdullah AM. Peptic ulcer disease in children and adolescents. J Trop Pediatr 2004;50:328-30.
14. 14. Datta D, Roychoidhury S. To be or not to be: the host genetic factor and beyond Helicobacter pylori mediated gastro-duodenal diseases. World J Gastroenterol 2015;21:2883-95.
15. 15. Diaconu S, Predescu A, Moldoveanu A, Pop CS, Fierbinteanu-Braticevici C. Helicobacter pylori infection: old and new. J Med Life 2017;10:112-7.
16. 16. Nord KS. Peptic ulcer disease in the pediatric population. Pediatr Clin North Am 1988;35:117-40.
17. 17. Barkun A, Leontiadis G. Systematic review of the symptom burden, quality of life impairment and costs associated with peptic ulcer disease. Am J Med 2010;123:358-66.
18. 18. Cardenas VM, Mulla ZD, Ortiz M, et al. Iron deficiency and Helicobacter pylori infection in the United States. Am J Epidemiol 2006;163:127-34.
19. 19. Dohil R, Hassall E. Peptic ulcer disease in children. Baillieres Best Pract Res Clin Gastroenterol 2000;14:53-73.