Peptic Ulcer Disease

Description

Diagnostic criteria

General and supportive measures

Medicine treatment

Referral

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ICD-10 code: K27

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 ⁷

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 ⁷

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.

Click here for the pdf.

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Standard Treatment Guidelines and Essential Medicines List for South Africa Paediatric Hospital _2023, 5th edition_Updated July 2024 

Chapter 2: Alimentary Tract, 2.2 Gastrointestinal Disorders, 2.2.9 Peptic Ulcer Disease