Peptic ulcer refers to a chronic ulcer in the stomach, duodenum, or jejunum after gastrojejunostomy. Since the ulcer is formed by the digestion of gastric acid and pepsin on the mucosa itself, it is called a peptic ulcer.

bubble_chart Diagnosis

(1) The disease can occur at any age, but is more common in children under 3 years old and over 10 years old. Acute ulcers are more prevalent in those under 3 years old, while chronic ulcers are more common in those over 10 years old. The incidence is higher in males than in females.

(2) Symptoms are often atypical. Chronic abdominal pain is the most common symptom, usually located in the upper abdomen or around the navel. In older children, the typical symptom is pronounced abdominal pain before meals and at night. Some children experience vomiting. Others may first seek medical attention due to complications such as upper gastrointestinal bleeding or acute perforation.

(3) Barium meal contrast examination of the digestive tract may reveal niches or indirect signs such as local deformation, irritation, and tenderness.

(4) Gastroscopy is the best method for diagnosing this condition. Findings during gastroscopy include: ulcers appearing round or oval, occasionally linear. The edges are neat, with surrounding mucosal congestion and edema but no nodular changes. The ulcer surface is covered with white or gray-white moss-like material, and mucosal folds converge toward the ulcer.

(5) Gastric acid levels are often not elevated. During the active phase of peptic ulcers, the stool occult blood test may sometimes be positive.

bubble_chart Treatment Measures

﹝Treatment﹞

With appropriate dietary adjustments, the use of antacids and antispasmodics, symptoms can quickly disappear, and the ulcer will heal on its own. (1) For mild cases, focus on a reasonable diet, mainly consisting of soft or easily digestible foods, with small, frequent meals. Avoid acidic and other irritating foods. In cases of minor bleeding, fasting is generally unnecessary. Infants can be given a milk-based diet, while older children should be given soft foods; otherwise, bleeding may worsen. For cases of significant or recurrent bleeding, absolute rest and temporary fasting are required. (2) Drug therapy 1. H2 receptor antagonists or antacids The current first-line drug is cimetidine, at 10 mg/kg, taken once nightly for 4–6 weeks as a course of treatment. The maintenance dose is 5–10 mg/kg, taken once nightly for 2–3 months. Alternatively, ranitidine can be used as the first choice, at 2–6 mg/(kg·d), divided into 2–3 oral doses per day, for 4–8 weeks as a course of treatment. 2. Mucosal protective agents Colloidal bismuth subcitrate, commercially known as De-Nol, is administered at a pediatric dose of 1/2–1 packet (each containing 300 mg of colloidal bismuth), taken 3–4 times daily, half an hour before meals and at bedtime, for 6 weeks as a course of treatment. 3. Anti-Helicobacter pylori drugs Clinically, ampicillin or amoxicillin is commonly used, with an oral dose of 50–100 mg/(kg·d), divided into 3–4 doses. These drugs are often combined with the two aforementioned drug classes. (3) Treatment of complications For complications such as perforation, massive or recurrent bleeding, and pyloric obstruction, prompt surgical intervention is necessary.