eMedicine Specialties > Pediatrics: General Medicine > Gastroenterology

Peptic Ulcer Disease: Follow-up

Author: Mutaz I Sultan, MBChB, Instructor and Fellow, Department of Pediatrics, Division of Gastroenterology and Nutrition, Medical College of Wisconsin, Children's Hospital
Coauthor(s): B UK Li, MD, Professor of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Director, Pediatric Fellowships and Gastroenterology Fellowship, Medical Director, Functional Gastrointestinal Disorders and Cyclic Vomiting Program, Medical College of Wisconsin; Attending Gastroenterologist, Children's Hospital of Wisconsin; Ameesh Shah, MD, Assistant Professor of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Children's Memorial Hospital
Contributor Information and Disclosures

Updated: Nov 5, 2009

Follow-up

Further Inpatient Care

  • Admit patients with peptic ulcer disease (PUD) to the hospital for stabilization, supportive care, and diagnostic testing.

Further Outpatient Care

  • Carefully monitor medication doses, adverse effects of medications, and relief or persistence of symptoms.

Inpatient & Outpatient Medications

  • Medications include blockers of gastric acid secretion, acid neutralizers, and antibiotics.
  • Avoid all irritative medications, including nonsteroidal anti-inflammatory drugs (NSAIDs), aspirin, and corticosteroid preparations.
  • Patients with iron-deficiency anemia (IDA) may require iron-replacement therapy.

Transfer

  • Transfer to a tertiary care children's hospital may be necessary for children who are seriously ill and require critical care or for patients who need emergent subspecialty diagnostic and therapeutic intervention.

Complications

  • Pain
  • Anemia
  • Bleeding
  • Perforation
  • Obstruction
  • Death

Prognosis

  • Mortality rates are low in older children with primary ulceration and H pylori infection.
  • Mortality rates remain highest in neonates, as well as infants and children with systemic illness or injury, who present with acute bleeding or perforation.
  • Children with duodenal ulceration associated with H pylori infection are not expected to die.

Patient Education

  • Familiarize patients and families with the predisposing factors for peptic ulcer disease that can be modified, including diet, medication use, alcohol ingestion, emotional stressors, and use of tobacco products.
  • For excellent patient education resources, visit eMedicine's Esophagus, Stomach, and Intestine Center. Also, see eMedicine's patient education article, Peptic Ulcers.

Miscellaneous

Medicolegal Pitfalls

  • In children with severe symptoms, acute GI hemorrhage, instability, or critical illness, failure to appropriately stabilize the patient's condition and transfer him or her to a facility that provides definitive subspecialty care
  • In a child with serious illness or traumatic injury, failure to optimize critical care and take the necessary steps to prevent secondary ulceration
  • Failure to appropriately examine and perform a workup in children with abdominal pain or any evidence of GI bleeding
  • Failure to recognize and treat associated H pylori infection

Special Concerns

  • Although a notable percentage of children with abdominal pain may have functional disease, self-limited viral illnesses, or constipation, thorough history taking, physical examination, and consideration of the possibility of peptic ulcer disease (PUD) is warranted in any patient with GI complaints.
 


More on Peptic Ulcer Disease

Overview: Peptic Ulcer Disease
Differential Diagnoses & Workup: Peptic Ulcer Disease
Treatment & Medication: Peptic Ulcer Disease
Follow-up: Peptic Ulcer Disease
Multimedia: Peptic Ulcer Disease
References
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References

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Further Reading

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Keywords

peptic ulcer disease, PUD, primary ulcer, secondary ulcer, stress ulcer, peptic ulcer, gastric disease, stomach ulcer, intestinal ulcer, ulceration, infection, mucosal ischemia, treatment, diagnosis

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Contributor Information and Disclosures

Author

Mutaz I Sultan, MBChB, Instructor and Fellow, Department of Pediatrics, Division of Gastroenterology and Nutrition, Medical College of Wisconsin, Children's Hospital
Mutaz I Sultan, MBChB is a member of the following medical societies: American Gastroenterological Association and North American Society for Pediatric Gastroenterology, Hepatology and Nutrition
Disclosure: Nothing to disclose.

Coauthor(s)

B UK Li, MD, Professor of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Director, Pediatric Fellowships and Gastroenterology Fellowship, Medical Director, Functional Gastrointestinal Disorders and Cyclic Vomiting Program, Medical College of Wisconsin; Attending Gastroenterologist, Children's Hospital of Wisconsin
B UK Li, MD is a member of the following medical societies: Alpha Omega Alpha, American Gastroenterological Association, and North American Society for Pediatric Gastroenterology and Nutrition
Disclosure: Nothing to disclose.

Ameesh Shah, MD, Assistant Professor of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Children's Memorial Hospital
Ameesh Shah, MD is a member of the following medical societies: North American Society for Pediatric Gastroenterology and Nutrition
Disclosure: Nothing to disclose.

Medical Editor

Chris A Liacouras, MD, Director of Pediatric Endoscopy, Department of Pediatrics, Division of Gastroenterology and Nutrition, Associate Professor, Children's Hospital of Philadelphia and University of Pennsylvania
Chris A Liacouras, MD is a member of the following medical societies: American Gastroenterological Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

B UK Li, MD, Professor of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Director, Pediatric Fellowships and Gastroenterology Fellowship, Medical Director, Functional Gastrointestinal Disorders and Cyclic Vomiting Program, Medical College of Wisconsin; Attending Gastroenterologist, Children's Hospital of Wisconsin
B UK Li, MD is a member of the following medical societies: Alpha Omega Alpha, American Gastroenterological Association, and North American Society for Pediatric Gastroenterology and Nutrition
Disclosure: Nothing to disclose.

CME Editor

Steven M Schwarz, MD, FAAP, FACN, AGAF, Professor of Pediatrics, Children's Hospital at Downstate, SUNY-Downstate Medical Center
Steven M Schwarz, MD, FAAP, FACN, AGAF is a member of the following medical societies: American Academy of Pediatrics, American College of Nutrition, American College of Physician Executives, American Gastroenterological Association, American Pediatric Society, Gastroenterology Research Group, New York Academy of Medicine, North American Society for Pediatric Gastroenterology and Nutrition, and Society for Pediatric Research
Disclosure: TAP Pharmaceuticals Honoraria Speaking and teaching; Curemark, LLC Consulting fee Board membership; Centocor, Inc. Grant/research funds Independent contractor

Chief Editor

Carmen Cuffari, MD, Associate Professor, Department of Pediatrics, Division of Gastroenterology/Nutrition, Johns Hopkins University School of Medicine
Carmen Cuffari, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

 
 
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