An ulcer in a child is called a peptic ulcer in the academic literature. This is a chronic disease that occurs with relapses, is expressed by the presence of an ulcer in the mucous membrane of the stomach and / or duodenum.
Reasons
According to recent research, medicine's view of the causes of duodenal ulcer in children has changed significantly. To date, the following reasons are considered to be the most common prerequisites for an ulcer in a child:
- If the bacterium Helicobacter Pylori is found in the stomach. After infection with this bacterium, pathological, destructive processes begin in the stomach, which lead to the appearance of ulcers on the walls of the stomach and duodenum.
- Excessive production of stomach acid and pepsins can lead to peptic ulcers.
- Weaken the protective mechanisms of the stomach and provoke a peptic ulcer can take anti-inflammatory nonsteroidal drugs. The insidiousness of these substances lies in the fact that they are present in the most seemingly accessible andpopular painkillers and inflammation-relieving drugs (Ibuprofen, Aspirin) while having side effects such as disruption of mucus production in the stomach, impaired blood circulation and restoration of stomach cells.
- Unbalanced diet of a child can provoke a peptic ulcer (overabundance of fried, fatty and spicy foods, overeating, long breaks between meals); stress, both psychological and physical (trauma) can cause peptic ulcer in a child.
Main symptoms
Basically, the symptoms of peptic ulcer in children is often manifested pain in the abdomen. As a rule, this is the upper part of it. Sometimes the pain radiates to the back, under the shoulder blade or to the lumbar region.
Peptic ulcer is also accompanied by nocturnal attacks and hunger pains. They usually subside immediately after eating, but after a while they resume again, especially after physical exertion.
Signs
Accompanying features of peptic ulcer in children are also:
- nausea;
- vomit;
- constant heartburn;
- deterioration of sleep;
- bloating;
- frequent constipation;
- poor appetite;
- belching with unpleasant, usually sour air.
Prolonged manifestation of symptoms leads to weight loss, emotional disturbances, including depression and the appearance of various phobias in the child.
Languagebecomes densely furred, jams appear in the corners of the mouth. Skin and hair become weak and dry, nails become brittle. Often the symptoms of peptic ulcer can be confused with manifestations of chronic gastritis, because its diagnosis requires a careful approach and immediate qualified treatment.
Diagnosis
Drug therapy of peptic ulcer for different causes is different, so timely and thorough diagnosis of the disease is very important. The main diagnostic procedures, in addition to physical examination and collection of an anamnesis of heredity, include the following activities:
- Determining the presence of Helicobacter Pylori bacteria in the stomach. In modern clinics, the so-called breath test is used, but, in addition, stomach infections can be diagnosed through the examination of pieces of tissue during endoscopy, the study of a blood test for the presence of antibodies to this bacterium, and the study of feces for an antigen to H. Pylori.
- X-ray of the upper gastrointestinal tract. Taking a special liquid (barium suspension) allows you to determine the clear boundaries of organs and take a high-quality picture.
- Endoscopic examination causes certain difficulties in carrying out, but gives the most accurate picture of the condition of the stomach. A thin tube with a miniature luminous camera at the end is inserted through the oral cavity, this allows you to examine in detail all the pathological changes on the walls of the stomach. In addition, during theendoscopy, it is possible to take a piece of damaged tissue for a biopsy (structural analysis).
Timely diagnosis will prevent complications of peptic ulcer in children and protect against consequences.
Non-pharmacological treatments
There are two ways to cure a sick child from a peptic ulcer: pharmacological and non-pharmacological.
Non-pharmacological treatment consists of:
- personal psychotherapy;
- if this is possible, then the treatment is through the rejection of ulcerogenic drugs.
The course of procedures for recovery from peptic ulcers in children is recommended to start with a simple diet. Before eating, all food is grated or made in the form of a watery or slightly thick mixture, they need to be boiled in water or steamed.
If the disease is quite easy, without heartburn or pain, then this diet will work without the use of additional treatment. When the ulcer begins to slowly disappear, it is necessary to monitor nutrition and eat fully, count the amount of carbohydrates, fats and proteins consumed, and also take the necessary vitamins in sufficient quantities.
Exclude smoked food, canned food (both meat and fish), you can not eat a lot of vegetables, which include an increased amount of oils and fiber, for example, radish.
Pharmacology
Treatment of peptic ulcer in children (duodenum and stomach) by pharmacological meansconsists of several procedures, reasoned, with the use of antisecretory methods. The treatment of the disease is determined not only by the duration, but also by the ability to keep the intragastric pH above three for a certain time, in fact, this contributes to the healing of the ulcer.
Of all antisecretory substances, H2 blockers are the best, they delay the production of pepsin and hydrochloric acid in parietal cells. Famotidine is the most used drug in pediatrics due to the least likely adverse effects that can be caused by the use of ranitidine. It is taken once in eighteen hours, no more than forty milligrams can be taken per day. The course of treatment can last no more than eight months and no less than four.
Now one of the most powerful antisecretory products are proton pump blockers, they guarantee the transport of H +, consisting of K + cells, into the cell, therefore, they take part in the work of the proton pump, channels and parietal cells of the stomach, which gives the most strong medical effect on gastric secretion to date. All inhibitors guarantee a long time, day and night, when the H2 indicator becomes positive for the treatment of ulcers, we do not take into account substances that work well for Helicobacter pylori infections.
Side effects are not excluded in the form:
- malaise;
- frequent change from diarrhea to constipation;
- pain in the head;
- rash onskin.
Therefore, the chosen medicine should be used no longer than two months, and no more than once a day. Smoother agents such as omeprazole are best recommended.
When using lansoprazole or rabeprazole, the effect will be stronger, but the likelihood of side effects in children is much higher. With the support of histamine H2 receptor blockers, you can get rid of all the difficulties of the disease, except for one, they do not guarantee the exclusion of the possibility of a recurrence of the disease.
Colloidal bismuth subcitrate can be used as a base product for a long period of time, it has an antacid effect and promotes the appearance of a colloidal mass in the form of a film. The product has a positive effect on the quantitative and high-quality properties of gastric mucus, lowers the energy of pepsin, and affects Helicobacter pylori. You need to apply it one piece an hour before meals, no more than three times a day. The duration of the course is not less than four and not more than eight months. You need to be prepared for possible negative consequences in the form of lightheadedness, nausea, the stool may become dark in color, it is undesirable to use it in case of kidney disease.
It is necessary to take into account the role of Hp, its eradication is important, in fact, which reduces the number of recurrences of the disease. The main rules of such therapy are to get rid of Hp in control studies. The best effect can be achieved if the course lasts at least seven and no more than fourteen days (full compliance with the cost of the drug and its safety).
Complex Therapy
Now is the bestuse compositions of three or four medications, while not only drugs, but also basic substances have anti-Helicobacter properties.
Possible treatment options:
- Combination of colloidal bismuth subcitrate, flemoxin, solyutab and furazolidone.
- Colloidal bismuth subcitrate, Solutab and Flemoxin.
- Combination of colloidal bismuth subcitrate, furazolidone and clarithromycin.
- Quad therapy consists of omeprazole, Solutab and bismuth subcitrate.
Given the serious role of abnormalities in the motility of the gastrointestinal tract, a significant space in the cure is given to prokinetics - these are substances that improve motility, instead of widely used blockers that carry serious side effects, domperidone is now often used, it is considered a peripheral blocker, it eliminates central side effects, as well as cisapride, it initiates the release of acetylcholine in the plexuses of the gastrointestinal tract, since it connects the neuronal plexuses using HT-4 receptors.
The listed methods of treatment provide an opportunity for successful treatment of peptic ulcer, elimination of possible exacerbations and prevents the recurrence of the disease. The best rates of therapy with various medications remain with doctors who deal with the most severe forms of the disease. In this case, they rely on a little popular surgery, which consists in stopping stomach bleeding with the support of the mostknown endoscopic method. Carrying out a simplified treatment of peptic ulcer, only in the case of absolute refractoriness to a progressive cure, they resort to the use of laparoscopic highly selective vagotomy.
Prevention
The main cause of peptic ulcer disease is infection of the bacteria Helicobacter pylori. That is why the main measure for the prevention of peptic ulcer in children (stomach and duodenum) is hygiene.
It is important to remember that the bacterium is transmitted through saliva, so each family member should have separate toothbrushes and towels, this should also be paid special attention to while the child is at school or kindergarten. Kissing between family members and acquaintances should be limited.
Additional events
Additional measures to prevent peptic ulcer include the following:
- Dental treatment at the first signs of caries or toothache, as an unhe althy chewing apparatus cannot ensure the thoroughness of chewing food, which leads to an increase in acidity in the stomach.
- Proper diet, that is, fried, smoked and canned food, an abundance of flour products and carbonated drinks should be excluded from the daily menu.
- Products should be subjected to a gentle heat treatment regime, preference should be given to steaming, boiling or baking in the oven at low temperatures rather than smoking orfrying.
- No stress, calm lifestyle and measured daily routine.
Diet
In the first few days from the start of treatment for gastric ulcer in children, according to clinical recommendations, only steamed or boiled, thoroughly grated food is given. Products that increase the secretory function of the stomach are completely excluded from the diet. Meals are served unders alted.
A child should take food 6-8 times a day in small portions of about 200 gr. The range of permitted products includes:
- whole milk;
- butter and cream;
- soft-boiled eggs;
- jelly and kissels from fresh, finely grated berries;
- light meat and vegetable broths;
Lean meat soufflé: beef, veal, rabbit, turkey, chicken and pork. Cream soups of vegetables and meat with rice or semolina.
As drinks, preference is given to rosehip and chamomile broth, as well as sweet fruit and berry juices diluted in half with rice broth.
The temperature of the food served should be between 38-40 degrees. All bakery and flour products, including pasta and crackers, are completely excluded from the diet, as they significantly increase the secretion of the stomach and can lead to an exacerbation of the disease. The same applies to sweets.
But the above diet cannot meet all the physiological needs of the child, therefore, on the 3-4th day of treatment, the listdishes are introduced:
- white bread (it should be slightly dried in the oven);
- cereals and soups with milk;
- meat and fish steam cutlets, quenelles, meatballs and meatballs;
- in the absence of allergies, honey is used as an additional remedy, as it normalizes the secretory function of the stomach and promotes the healing of minor injuries in it.
According to clinical guidelines for peptic ulcer in children, mineral water heated to 45 degrees can be included as a drink, taken one hour before meals.
