Peptic ulcer disease

K27

• Description
• Diagnostic criteria
• General and supportive measures
• Medicine treatment
• Referral

DESCRIPTION

Varying degrees of gastritis or frank ulceration of the stomach or duodenum due to acid and pepsin-laden stomach contents on the gastric and duodenal mucosa in the face of inability of mucosal defence mechanisms to prevent these effects.
Peptic ulcers may be primary (e.g. Helicobacter pylori related) or secondary, (e.g. stress related or associated with NSAID use).

DIAGNOSTIC CRITERIA

Clinical

• Haematemesis or melaena is a relatively common presentation in children (up to 50%).
• Epigastric pain. Pain is often poorly localised in children, described as dull and aching and frequently does not respond to antacids.

Investigations

• Endoscopy to confirm diagnosis.

GENERAL AND SUPPORTIVE MEASURES

• Manage circulation and anaemia, as required.
• Stop all non-steroidal anti-inflammatory agents.
• Remove all stressors identified.

MEDICINE TREATMENT

• Proton pump inhibitor, e.g.:
• Omeprazole, oral, 0.7-1.4 mg/kg/day once daily. Specialist initiated.
  • Maximum dose: 20-40 mg/dose.
    If 1 month–2 years: 5 mg once daily.
    If > 2–6 years: 10 mg once daily.
    If > 7–12 years: 20 mg once daily.

LoE: III[8]

PLUS

If Helicobacter pylori positive. (Not routine)

• Metronidazole, oral, 7.5 mg/kg 12 hourly for 14 days.
  PLUS
  
• Amoxicillin, oral, 25–30 mg/kg 12 hourly for 14 days.

LoE: III[9]

Penicillin allergy
In case of severe penicillin allergy replace amoxicillin with:

• Azithromycin, oral, 10mg/kg daily for 5 days.

REFERRAL

• Poor response to treatment.
• Suspicion of underlying cause.