MODERN APPROACHES TO PEPTIC ULCER IN CHILDREN AND ADOLESCENTS

Abstract

Introduction: Peptic ulcer disease (PUD), though traditionally associated with adults, is increasingly recognized as a significant clinical concern in children and adolescents. Pediatric peptic ulcers result from an imbalance between aggressive factors, such as gastric acid, pepsin, Helicobacter pylori infection, and nonsteroidal anti-inflammatory drug (NSAID) use, and protective mucosal mechanisms. The condition presents diagnostic challenges due to nonspecific symptoms and may lead to serious complications, including gastrointestinal bleeding, perforation, and gastric outlet obstruction. Understanding modern diagnostic and therapeutic approaches is essential for improving outcomes in pediatric populations.

Materials and Methods: This study employed a systematic literature review of peer-reviewed articles, clinical guidelines, and meta-analyses focusing on peptic ulcer disease in children and adolescents. Data were sourced from reputable medical databases, including PubMed, the Cochrane Library, and Scopus. Emphasis was placed on studies published within the last decade to ensure relevance to contemporary clinical practice. The review analyzed epidemiology, pathophysiology, risk factors, complications, and both pharmacological and non-pharmacological treatment strategies.

Results: The findings indicate that H. pylori infection remains a primary cause of peptic ulcers in pediatric populations, particularly in developing regions, while NSAID-induced ulcers are increasing globally. Proton pump inhibitors (PPIs) are the most effective pharmacological agents for acid suppression and ulcer healing. Combination antibiotic therapy demonstrates high eradication rates for H. pylori, although rising antibiotic resistance presents therapeutic challenges. Histamine-2 receptor antagonists, mucosal protective agents, and lifestyle modifications serve as adjunctive therapies. Non-pharmacological measures, including dietary management and stress reduction, contribute to symptom control and prevention. Surgical intervention is reserved for refractory or complicated cases.

Conclusion: Modern management of peptic ulcers in children and adolescents requires a comprehensive, individualized approach that integrates accurate diagnosis, effective pharmacological therapy, eradication of H. pylori, and preventive strategies. Although progress has been made in reducing infection-related ulcers, increasing NSAID use and emerging antibiotic resistance necessitate ongoing research and updated clinical protocols. Early recognition and evidence-based management are critical to preventing complications and improving long-term pediatric health outcomes.