Peptic ulcer (gastric and duodenal ulcer)

Japanese: 消化性潰瘍（胃・十二指腸潰瘍） - しょうかせいかいよう（い・じゅうにしちょうかいよう）（英語表記）Peptic ulcer (Gastroduodenal ulcer)

What is the disease?

A peptic ulcer is a condition in which the mucous membrane of the stomach or duodenum has been deeply damaged for some reason. In recent years, endoscopic examinations have become more common in children, and there are many cases where a definitive diagnosis is made.

It has also been discovered that Helicobacter pylori (H. pylori) infection is one of the causes of peptic ulcers. Most gastric ulcers are H. pylori negative acute ulcers and occur in people under 6 years old, while most duodenal ulcers are H. pylori positive chronic ulcers and tend to occur in people over 10 years old.

What is the cause?

The causes are divided into two categories: Helicobacter pylori positive and negative. In positive cases, the ulcer is caused by persistent infection with Helicobacter pylori, while in negative cases, it is caused by stress, medication such as painkillers and steroids, or other factors. Eosinophilic ( Thank you ) Possible causes include gastroenteritis, Ménétrier's disease, Crohn's disease, and, very rarely, Zollinger-Ellison syndrome.

How symptoms manifest

Gastric ulcers are often acute, and symptoms appear suddenly. Other than that, gastric ulcers and duodenal ulcers show similar symptoms, and it is difficult to distinguish between the two from the symptoms alone. Both are accompanied by abdominal pain, nausea, vomiting, hematemesis, and tarry stools. Infants and young children may vomit large amounts of blood or have intestinal problems. Hole ( hole ) Gaaki (intestinal Perforation ( flash ) ), which may require emergency surgery.

Duodenal ulcers generally cause abdominal pain when hungry, but this is relieved by eating. Most patients feel pain around the solar plexus, slightly to the right. Vomiting and anemia may also occur.

Testing and diagnosis

If a digestive ulcer is strongly suspected based on the above symptoms, an upper gastrointestinal endoscopy is extremely useful, but currently there are only a limited number of facilities that can perform endoscopy on children. Contrast examinations are also performed, but ulcers in children are shallow and diagnosis may not be possible.

Helicobacter pylori infection is detected by histopathological examination and culture of mucous membranes taken by endoscopy, as well as serum antibody and Urea breath ( Nyosokki ) The diagnosis is made using the test results.

Treatment methods

If bleeding is severe, emergency endoscopy will be used to stop the bleeding and, if necessary, a blood transfusion will be administered. If endoscopic hemostasis is difficult or intestinal perforation occurs, surgery will be indicated. If there are no such complications, the prognosis is good.

The mainstay of treatment is acid secretion suppressants (such as _H2 blockers). If H. pylori is positive, eradication therapy using three types of oral medication may be administered to prevent recurrence. In recent years, drug-resistant H. pylori has been increasing, so an endoscopic examination must be performed before starting treatment to determine the treatment. Approximately 20% of patients experience side effects such as diarrhea and abnormal taste, and if treatment is incomplete, subsequent eradication will be difficult, so treatment by a specialist is required.

In children aged 5 years or older, the rate of ulcer recurrence after successful eradication is very low at 2-3%.

What to do if you notice an illness

There is a preconceived notion that gastric and duodenal ulcers are diseases of adults, but they can occur in any age group from newborns to adolescents. If your child is vomiting blood or has tarry stools, or if they have persistent abdominal pain, you should see a pediatrician.

Hidenori Haruna

Source: Houken “Sixth Edition Family Medicine Encyclopedia” Information about the Sixth Edition Family Medicine Encyclopedia

Japanese:

どんな病気か

　消化性潰瘍とは、何らかの原因で胃・十二指腸の粘膜が深く損傷した状態になっていることをいいます。近年、子どもの領域でも内視鏡検査が普及してきたことにより、確定診断されるケースが少なくありません。

　また、ヘリコバクター・ピロリ（以下、ピロリ菌）感染が、消化性潰瘍の一因であることがわかってきています。胃潰瘍の多くはピロリ菌陰性の急性潰瘍で6歳以下に、十二指腸潰瘍の多くはピロリ菌陽性の慢性潰瘍で10歳以上に多い傾向があります。

原因は何か

　原因はピロリ菌陽性と陰性によって2つに分けられます。陽性例では、ピロリ菌の持続感染による潰瘍であり、陰性例では、ストレス性、鎮痛薬やステロイド薬による薬物性、好酸球性(こうさんきゅうせい)胃腸炎、メネトリエ病のほかに、クローン病、非常にまれですがゾリンジャー・エリスン症候群などが原因として考えられます。

症状の現れ方

　胃潰瘍は急性潰瘍が多く、突然症状が現れます。それ以外は胃潰瘍、十二指腸潰瘍とも類似の症状を示し、両者の区別は症状だけからは困難です。両者とも腹痛、吐き気、嘔吐、吐血やタール便を伴います。乳幼児では大量吐血をしたり、腸に孔(あな)があき（腸管穿孔(せんこう)）、緊急手術になることもあります。

　一般に十二指腸潰瘍は、空腹時の腹痛を訴えますが、食事をとると軽減します。多くはみぞおち周囲からやや右よりを痛がります。嘔吐や貧血を伴うこともあります。

検査と診断

　前記の症状から消化性潰瘍が強く疑われる場合は、上部消化管内視鏡検査が極めて有用ですが、子どもの内視鏡が可能な施設は限られているのが現状です。造影検査も行われますが、子どもの潰瘍は浅く、診断がつかないことがあります。

　ピロリ菌感染の検索は、内視鏡で採取した粘膜の病理組織検査、培養などのほかに、血清抗体や尿素呼気(にょうそこき)試験の結果を用いて診断します。

治療の方法

　出血がひどい場合は緊急内視鏡で止血し、必要であれば輸血をします。内視鏡的に止血が困難な場合や腸管穿孔を来した場合は、外科手術の適応となります。そのような合併症がなければ、予後は良好です。

　治療の中心は、酸分泌抑制薬（H₂ブロッカーなど）です。ピロリ菌が陽性であった場合は、再発を防ぐ目的で、3種類の内服薬による除菌療法を行うことがあります。近年は薬剤耐性をもつピロリ菌も増えてきており、治療開始前に内視鏡検査を行って治療薬を決定することが必要です。20％程度に下痢や味覚異常などの副作用があり、治療が不完全だとその後の除菌が困難になるため、専門医による治療が必要です。

　5歳以上の子どもでは、除菌成功後の潰瘍再発率は2～3％と、ほとんどありません。