Primary peptic ulcer disease in not known to be the result of underlying illness or trauma. These are most frequently duodenal or prepyloric. Since clinical features of peptic ulcer in children can easily be confused with many other disorders, the diagnosis is usually made when one of the more dramatic presentations, such as perforation, bleeding and obstruction. Recently, we experienced 2 cases of duodenal obstruction due to peptic ulcer in children. So, we report it with review of references.
Child* ; Diagnosis ; Duodenal Obstruction* ; Hemorrhage ; Humans ; Peptic Ulcer*

BACKGROUND/AIMS: Helicobacter pylori eradication promotes healing and prevents recurrence of H. pylori associated peptic ulcer disease (PUD). However it is unclear whether H. pylori eradication therapy commenced on the initial course of treatment is more effective compared to therapy at a later course of treatment. We evaluated the optimal commencement time of eradication of H. pylori in patients with hemorrhagic PUD. MATERIALS AND METHODS: Between June 2002 through July 2013, a total of 486 patients who had hemorrhagic PUD were retrospectively evaluated. After exclusion, 79 patients who received H. pylori eradication therapy were assessed. RESULTS: Thirty patients with duodenal ulcer (38%) and 49 patients with gastric ulcer (62%) were enrolled. The overall eradication rate were 96.2%. The eradication rates of early eradication vs. late eradication (divided by standards of 3 days after diagnosis of PUD) were 94.3% vs. 100%, and was not significantly different (P=0.55). CONCLUSIONS: According to our study, medication commencement time does not have an effect on the eradication rate of H. pylori infection in patients with hemorrhagic PUD.
Diagnosis ; Duodenal Ulcer ; Helicobacter pylori* ; Hemorrhage* ; Humans ; Peptic Ulcer* ; Recurrence ; Retrospective Studies ; Stomach Ulcer

BACKGROUND/AIMS: The incidence of Helicobacter pylori (H. pylori)-positive ulcer appears to be decreasing recently in the Western countries, and this has been influenced by the epidemiologic changes of H. pylori infection. Therefore, we aimed to determine the trends for the frequency of H. pylori-positive peptic ulcer disease (PUD) during recent 7 years in Korea. METHODS: All 1,723 patients who had an endoscopic diagnosis of PUD from 1997 to 2003 were included in this study. H. pylori was considered present if the CLO test and/or the histology and the urea breath test were positive for H. pylori. RESULTS: H. pylori-positive ulcers were seen in 1,354/1,723 patients (78.6%). The positive rate of H. pylori infection in patients with PUD was 85.9% in 1997, 79.2% in 1999, 76.2% in 2001 and 73.1% in 2003, and this showed a decreasing annual trend (p<0.001). H. pylori-positive PUD was more prevalent in duodenal ulcer than in gastric ulcer, and in the patients who were aged person and male. During the recent 7 years, H. pylori- positive PUD has decreased in patients with duodenal ulcer, and especially for patients younger than 60 years and in the male group. CONCLUSIONS: The frequency of H. pylori-positive PUD is possibly decreasing in the recent 7 years. Prospective, multicenter trial studies are necessary to confirm this trend and find out the cause.
Breath Tests ; Diagnosis ; Duodenal Ulcer ; Helicobacter pylori ; Helicobacter* ; Hospitals, General* ; Humans ; Incidence ; Korea ; Male ; Peptic Ulcer* ; Stomach Ulcer ; Ulcer ; Urea

Endoscopy has been the method of choice for the initial diagnosis and treatment of gastrointestinal bleeding. However, in the case of difficult localization or endoscopic failure, angiographic or surgical alternative may be recommended. The role of angiography has been emphasized recently to control upper GI bleeding. We experienced a case with deep ulcer displaying exposed vessel along the duodenal bulb, which imposed serious rebleeding risk. Although, active bleeding was controlled by the epinephrine injections in that patient, rebleeding risk was still high. So the patient underwent emergency angiography with embolization of the pancreaticoduodenal artery and gastroduodenal artery using multiple microcoils. Follow-up endoscopic examinations showed a coil protruding into the lumen from the ulcer bed, and the exposed coil at the ulcer base was completely by the regenerated epithelium three months later. Here in, we describe the rare case of a endodcopically exposed coil after embolization for bleeding duodenal ulcer which is the first case ever reported in Korea.
Angiography ; Arteries ; Diagnosis ; Duodenal Ulcer* ; Emergencies ; Endoscopy ; Epinephrine ; Epithelium ; Follow-Up Studies ; Hemorrhage* ; Humans ; Korea ; Ulcer

The findings of upper gastrointestinal series(UGI), computed tomography (CT), and sonography(US) of ten duodenal adenocarcinoma confirmed by surgery (n=7) and endoscopic biopsy (n=3) were retrospectively analyzed. We performed US in all cases, CT and UGI in 8 out of 10 cases. UGI showed 4 cases of ulcerating type, 3 of stenotic type, and one failed to visualize duodenum due to previous gastrojejunostomy. UGI was more accurate in depicting the mucosal changes such as ulcer, however, it played a limited role in the evaluation of extraluminal extension. US showed 4 cases of hypocchoic wall thickening, 3 of hypoechoic extraluminal mass, and one of polypoid intraluminal mass but 2 were not detected on US. US accurately detected hepatic and pancreatic metastasis, however, it played a limited role in the evaluation of direct colonic invasion. CT showed was eccentric wall thickening in 4 cases, large extraluminal mass in 2, and low density intraluminal mass in but one was missed on CT. CT was the most accurate modality to determine the extent of the lesion and adjacent or distant metastasis but it could be misdiagnosed as submucosal tumor if the extraluminal component is large. UGI, CT and US can be used complementary for accurate diagnosis of a duodenal cancer. US may be used as a screening tool for detecting duodenal cancer.
Adenocarcinoma* ; Biopsy ; Colon ; Diagnosis ; Duodenal Neoplasms ; Duodenum* ; Gastric Bypass ; Mass Screening ; Neoplasm Metastasis ; Retrospective Studies ; Ulcer

An annular pancreas consists of a band or ring of pancreatic tissue which surrounds the second portion of the duodenum is a rare congenital anomaly which may cause duodenal obstruction or remain silent throughout life. In an adult, symptoms from annular pancreas usually present between the ages of 20-50yr as duodenal obstruction. Peptic ulcer disease and pancreatitis may be found in association with symptomatic adult annular pancreas. The preoperative diagnosis of annular pancreas is often difficult. Although an upper gastrointestinal series is considered the diagnostic test, recognition is not always easy preoperatively. Recently, with the increased use of endoscopic retrograde cholangiopancreatography, patients with this anomaly were more frequently reported. In this report we describe two patients in whom the diagnosis of annular pancreas was clearly established by endoscopic retrograde cholangiopancreatography and one patient of suspected annular pancreas which was confirmed by surgery.
Adult* ; Cholangiopancreatography, Endoscopic Retrograde ; Diagnosis ; Diagnostic Tests, Routine ; Duodenal Obstruction ; Duodenum ; Humans ; Pancreas* ; Pancreatitis ; Peptic Ulcer

The pneumoretroperitoneum has many etiologies. These range from the clinically insignificant to the potentially fatal, if not recognized promptly. Spontaneous pneumoretroperitoneum can develope from ulcerative colitis, colonic diverti-culitis, or duodenal ulcer perforation. It can be associated with pneumothorax, pneumomediastinum, respiratoy tract rupture, etc. An isolated pneumoretroperitoneum are a more obscure symptom than a pneumoperitoneum. Mostly, the diagnosis of retroperitoneal air depends of radiologic methods, such as simple X-ray, ultrasound (US), or computerized tomography (CT) measurements. In this case, we diagnosed a pneumoretroperitoneum from CT and found that it caused the perforation of the colon spontaneously, without any underlying diseases, due to chronic constipation without underlying diseases
Colitis, Ulcerative ; Colon ; Constipation ; Diagnosis ; Duodenal Ulcer ; Mediastinal Emphysema ; Pneumoperitoneum ; Pneumothorax ; Retropneumoperitoneum* ; Rupture ; Ultrasonography

Objective: To investigate the characteristics of duodenal bulbar microbiota in children with duodenal ulcer and Helicobacter pylori (Hp) infection. Methods: This prospective cohort study enrolled 23 children with duodenal ulcers diagnosed by gastroscopy who were admitted to the Children's Hospital of Zhejiang University School of Medicine due to abdominal pain, abdominal distension, and vomiting from January 2018 to August 2018. They were divided into Hp-positive and Hp-negative groups according to the presence or absence of Hp infection. Duodenal bulbar mucosa was sampled to detect the bacterial DNA by high-throughput sequencing. The statistical difference in α diversity and β diversity, and the relative abundance in taxonomic level between the two groups were compared. Microbial functions were predicted using the software PICRUSt. T-test, Rank sum test or χ² test were used for comparison between the two groups. Results: A total of 23 children diagnosed with duodenal ulcer were enrolled in this study, including 15 cases with Hp infection ((11.2±3.3) years of age, 11 males and 4 females) and 8 cases without Hp infection ((10.1±4.4) years of age, 6 males and 2 females). Compared with Hp-negative group, the Hp-positive group had higher Helicobacter abundance (0.551% (0.258%, 5.368%) vs. 0.143% (0.039%, 0.762%), Z=2.00, P=0.045) and lower abundance of Fusobacterium, Streptococcus and unclassified- Comamonadaceae (0.010% (0.001%, 0.031%) vs. 0.049% (0.011%, 0.310%), Z=-2.24, P=0.025; 0.031% (0.015%, 0.092%) vs. 0.118% (0.046%, 0.410%), Z=-2.10, P=0.036; 0.046% (0.036%, 0.062%) vs. 0.110% (0.045%, 0.176%), Z=-2.01, P=0.045). Linear discriminant analysis (LDA) effect sized showed that at the genus level, only Helicobacter was significantly enriched in Hp-positive group (LDA=4.89, P=0.045), while Streptococcus and Fusobacterium significantly enriched in Hp-negative group (LDA=3.28, 3.11;P=0.036,0.025, respectively). PICRUSt microbial function prediction showed that the expression of oxidative phosphorylation and disease-related pathways (pathways in cancer, renal cell carcinoma, amoebiasis, type 1 diabetes mellitus) in Hp-positive group were significantly higher than that in Hp-negative group (all P<0.05), while the expression of pathways such as energy metabolism and phosphotransferase system pathways were significantly lower than that in Hp-negative group (all P<0.05). Conclusion: In children with Hp-infected duodenal ulcers, the mucosal microbiota of the duodenal bulb is altered, characterized by an increased abundance of Helicobacter and a decreased abundance of Clostridium and Streptococcus, and possibly alters the biological function of the commensal microbiota through specific metabolic pathways.
Male ; Female ; Humans ; Child ; Duodenal Ulcer/diagnosis* ; Helicobacter Infections/complications* ; Helicobacter pylori/genetics* ; Prospective Studies ; Microbiota

PURPOSE: This study aimed at evaluating the therapeutic outcome, cost effectiveness and recurrence rate in children with H. pylori infection after the treatment using various medications. METHODS: Seventy five children (mean age 11.4+/-2.5 years) were given an endoscopy with biopsy and H. pylori status assessed by CLO test and histologic examination (Warthin Starry stain). Children were given one of following medications such as DA (Denol(R) and amoxycillin), OA (omeprazole and amoxycillin), DC (Denol(R) and clarithromycin) as primary treatment. And one of following medications such as DAM (Denol(R), amoxycillin and metronidazole), DC, OA, OC (omeprazole and clarithromycin) were used in children who failed the eradication of H. pylori. RESULTS: The endoscopic diagnoses were: nodular gastritis (46 cases), gastric ulcer (9), duodenal ulcer (6), superficial gastritis (6), and normal (8). H. pylori eradication rate was 91% (63 of 69 children) on 4 weeks course of DA, 50% (1 of 2 cases who had treatment failure on DA) on DAM, and 75% (3 of 4 cases who treated on DC primarily) and 50% (1 of 2 cases who had treatment failure on DA) on DC, and 100% on OA (all of 2) and on OC (all of 1 who failed on DA). In 3 of 7 children in whom H. pylori had not been eradicated by primary medications (DA 6 and DC 1 case), H. pylori was re-eradicated by secondary medications (DA 1, DAM 1 and DC 1 case). But in remaining 4 cases, H. pylori infection persisted. Reinfection of H. pylori was found in 4 of 75 children between 3 months and 3 years after completion of the treatment of DA, yielding recurrence rate of 5.3%. In 2 of 4 cases who had relapsed, H. pylori was re-eradicated by secondary medications (OC 1 and DA 1 case). But in remaining 2 cases, H. pylori infection persisted. CONCLUSION: These results suggest that dual therapy with Denol(R) and amoxycillin is the effective medications in treating H. pylori infection in children. Concerning the cost effectiveness, it can Austrabe recommended as first line treatment of choice as well.
Amoxicillin ; Biopsy ; Child* ; Cost-Benefit Analysis ; Diagnosis ; Duodenal Ulcer ; Endoscopy ; Gastritis ; Helicobacter pylori* ; Helicobacter* ; Humans ; Recurrence* ; Stomach Ulcer ; Treatment Failure

PURPOSE: This study was performed to analyze the endoscopic findings in Henoch-Schonlein purpura patients, and to compare the differences in endoscopic findings according to age and gastrointestinal symptoms. METHODS: We examined children with Henoch-Schonlein purpura aged 3 to 15 years between September 1996 and October 2002. The total number studied was 65, consisting of 41 boys and 24 girls. Endoscopy was performed and the results were analysed. RESULTS: Among 65 cases, 12 cases of duodenitis, nine cases of gastritis and duodenitis, six cases of duodenal erosion, five cases of gastritis, five cases of duodenal ulcer, two cases of gastric ulcer and one case of colonic erosion were noted. Endoscopic abnormality was found in 38 of 53 who had gastrointestinal symptoms, and in two of 12 who didn't have gastrointestinal symptoms. CONCLUSION: Most of the gastrointestinal symptoms in Henoch-Schonlein purpura patients were relieved without complication. But in some cases severe symptoms such as hematemesis, melena, and abdominal pain localized to epigastric area were developed when diagnosis was delayed. Prompt endoscopy will be helpful for diagnosis and therapy of Henoch-Schonlein purpura with gastrointestinal involvement.
Abdominal Pain ; Child* ; Colon ; Diagnosis ; Duodenal Ulcer ; Duodenitis ; Endoscopy ; Female ; Gastritis ; Hematemesis ; Humans ; Melena ; Purpura, Schoenlein-Henoch* ; Stomach Ulcer