Clinical Presentation. The clinical features of peptic ulcer disease in chil­dren can easily be confused with those of many other disorders; this similarity may inflate the actual

The clinical features of peptic ulcer disease in chil­dren can easily be confused with those of many other disorders; this similarity may inflate the actual incidence of ulcer disease in children (Tables 4.4). The diagnosis is often elusive until such complications as perforation or bleeding occur.

The symptoms of gastritis, peptic ulcer and duodenitis are similar and nonspecific. For children up to 2 years of age, these symptoms consist of recurrent vomiting, difficulty with feeds, growth delay and gastrointestinal bleeding. In preschool children, postprandial pain, vomiting and hemorrhage are the common presenting features.

Older children present similar to adults. The pain of peptic ulcer disease is often vague and difficult for young patients to describe. It may be temporally related to meals or relieved by eating. Nocturnal awakening caused by episodes of pain is a common feature and may differentiate organic from psychogenic pain. Anorexia, nausea, early satiety, eructation and vomiting all are common symptoms. Patients may present with obstruction due to chronic pyloric scarring, demonstrated by nonbilious emesis.

Six symptoms correlated significantly with acid-peptic disease: epigastric pain, nocturnal pain, postprandial pain, water brash, weight loss, and a family history of peptic ulcer disease.

Secondary ulcers are acute. Although the age of patients with secondary ulcers ranges from 1 day to 18 years, most patients are younger than 6 years of age. Secondary peptic ulcers are usually due to noxious agents (e.g., corticosteroids and NSAIDs) or after major stresses (e.g., burns, head injury, systemic illness). Diagnosis is therefore more difficult and usually made when a catastrophic event such as hemorrhage or perforation occurs. Gastrointestinal bleeding, the predominant presenting symptom of secondary ulcers, occurs in 92% of patients younger than 6 years of age.

Tables 4.4

Clinical Findings in Primary and Secondary Gastritis and Peptic Ulcer Disease (by Jay L. Grosfeld, 2006).

Disease Entity	Signs and Symptoms
Primary gastritis	· Recurrent abdominal pain (any location) · Epigastric pain · Water brash, heartburn (gastroesophageal reflux disease symptoms) · Vomiting, nausea, anorexia · Iron deficiency anemia · Short stature, growth failure (?)
Secondary gastritis	· Abdominal pain · Upper gastrointestinal blood loss - hematemesis, melena · Epigastric pain localization ("crampy") · Irritability, change in feeding patterns · Fatigue · Iron deficiency anemia
Primary peptic ulcer disease	· Chronic, recurrent abdominal pain · Episodic epigastric pain · Vomiting, particularly recurrent · Nocturnal awakening · Anemia
Secondary peptic ulcer disease	· Life-threatening gastrointestinal bleeding · Gastric or duodenal perforation · Shock · Abdominal pain (rare)

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