An ulcer in a child is called a peptic ulcer in the academic literature. This is a chronic disease that occurs with relapses, expressed by the presence of a peptic ulcer in the mucous membrane of the stomach and / or duodenum.
Causes
According to recent studies, in medicine, the view on the causes of duodenal ulcer in children has changed significantly. To date, the following causes are considered the most common prerequisites for an ulcer in a child:
- If the bacterium Helicobacter pylori is found in the stomach. After infection with the indicated bacterium, pathological, destructive processes begin in the stomach, which lead to ulceration on the walls of the stomach and duodenum.
- Excessive production of stomach acid and pepsins can lead to the formation of peptic ulcer.
- Weakening the protective mechanisms of the stomach and provoke peptic ulcer can take anti-inflammatory non-steroidal drugs. The insidiousness of these substances lies in the fact that they are present in the most seemingly affordable and popular painkillers and anti-inflammatory drugs ("Ibuprofen", "Aspirin"), while providing side effects such as impaired production of mucus by the stomach, circulatory disorders and restoration of the cells of the stomach.
- An unbalanced diet of a child can provoke a peptic ulcer (an excess of fried, fatty and spicy foods, overeating, long breaks between meals); stresses, both psychological and physical (injuries) can cause peptic ulcer in a child.
Main symptoms
Basically, the symptoms of peptic ulcer in children are often manifested pain in the abdomen. As a rule, this is its upper part. Sometimes pain is given in the back, under the scapula or in the lumbar region.
Peptic ulcer is also accompanied by night 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;
- vomiting
- constant heartburn;
- sleep impairment;
- bloating;
- frequent constipation;
- poor appetite
- belching with unpleasant, usually sour air.
A prolonged manifestation of symptoms leads to weight loss, emotional disturbances, including a depressive state and the appearance of various phobias in a child.
The tongue becomes thickly overlaid, and jellies appear in the corners of the mouth. Skin and hair become weak and dry, nails brittle. Often the symptoms of peptic ulcer can be confused with the manifestations of chronic gastritis, because its diagnosis requires a careful approach and immediate qualified treatment.
Diagnostics
Drug therapy for peptic ulcer for different causes of occurrence is different, therefore, timely and thorough diagnosis of the disease is very important. The main diagnostic procedures, in addition to a physical examination and a history of heredity, include the following:
- Determination of the presence of Helicobacter pylori bacteria in the stomach. In modern clinics, the so-called breathing test is used, but, in addition, it is possible to diagnose gastric infections by examining pieces of tissue during endoscopy, examining a blood test for the presence of antibodies to this bacterium, and studying feces for H. Pylori antigen.
- X-ray of the upper gastrointestinal tract. Reception of a special liquid (barium suspension) allows you to determine clear boundaries of organs and make a high-quality picture.
- Endoscopic examination causes certain difficulties in conducting, but gives the most accurate picture of the state of the stomach. A thin tube with a miniature luminous chamber at the end is inserted through the oral cavity, this allows you to examine in detail all pathological changes on the walls of the stomach. In addition, during endoscopy, 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.
Nonpharmacological treatment
There are two ways to cure a sick child from peptic ulcer: pharmacological and nonpharmacological.
Non-pharmacological treatment consists of:
- personal psychotherapy;
- if this is possible, then treatment is carried out with the help of rejection of ulcerogenic drugs.
The course of procedures for recovering from peptic ulcers in children is recommended to start with a simple diet. All food before use is grated or made in the form of a watery or slightly thick mixture, they need to be cooked in water or steamed.
In the event that the disease passes quite easily, without heartburn or pain, then this diet will work without the use of additional treatment. When the ulcer begins to slowly pass away, you must definitely monitor the diet and eat fully, consider the amount of carbohydrates, fats and proteins consumed, and also take the necessary vitamins in sufficient quantities.
To exclude smoked foods, canned foods (both meat and fish) from food, you can’t eat a lot of vegetables, which include an increased amount of oils and fiber, for example, radish.
Pharmacology
Pharmacological treatment of peptic ulcer in children (duodenum and stomach) consists of several procedures, reasoned, using 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 product in pediatrics because of the least likely negative consequences that can be caused by the use of ranitidine. Take it once in eighteen hours, a day it can be taken no more than forty milligrams. The course of treatment can last no more than eight months and at least four.
Now the proton pump blockers are considered to be one of the most powerful antisecretory products, they guarantee the H + transport, consisting of K + cells, inside the cell, therefore, they take part in the work of the proton pump, channels and lining cells of the stomach, which gives the strongest medical effect on the gastric secretion for today. All inhibitors guarantee a long time, day and night, when the H2 indicator is positive for the treatment of ulcers, we do not take into account substances that have a good effect on Helicobacter pylori infections.
Side effects in the form of:
- malaise;
- frequent change of diarrhea to constipation;
- headaches;
- skin rashes.
Therefore, the selected medicine should be used no longer than two months, and no more than once a day. Smoother substances, 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 one, they do not guarantee the exclusion of the possibility of re-disease.
For a long period of time, bismuth colloidal subcitrate can be used as a base product, 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. Apply it one thing 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. It is necessary to be prepared for possible negative consequences in the form of lightheadedness, nausea, the stool can become dark in color, it is undesirable to use for kidney disease.
It is necessary to take into account the role of HP, its eradication is important, in fact, which reduces the number of repetitions of the disease. The main rules of such therapy are in control studies to get rid of HP. 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 it is best to use compositions of three or four medications, while not only medicines, but also basic substances have anti-Helicobacter pylori properties.
Possible treatment options:
- The combination of colloidal bismuth subcitrate, flemoxin, solutab and furazolidone.
- Colloidal bismuth subcitrate, solutab and flemoxin.
- The combination of colloidal bismuth subcitrate, furazolidone and clarithromycin.
- Quadrotherapy consists of omeprazole, solutab and bismuth subcitrate.
Given the serious role of abnormalities in the motility of the gastrointestinal tract, a significant amount of space is allocated to prokinetics - these are substances that improve motility, instead of the widely used blockers that carry serious side effects, domperidone is often used now, it is considered to be a peripheral blocker, and central ones are excluded from it side effects, as well as cisapride, it initiates the release of acetylcholine in the plexuses of the gastrointestinal tract, since it connects the neural plexuses using NT-4 re the receptors.
The listed methods of treatment provide an opportunity for successful healing of peptic ulcer, elimination of possible exacerbations and prevents the recurrence of the disease. The best indicators of treatment with various medications remain with doctors who deal with the most severe forms of the disease. In this case, they rely on less popular surgery, which consists in stopping bleeding of the stomach with the support of the most famous endoscopic method. Conducting a simplified treatment of peptic ulcer, only in the case of absolute refractoriness, progressive treatment is resorted to using laparoscopic highly selective vagotomy.
Prevention
The main cause of peptic ulcer disease is Helicobacter pylori infection of bacteria. That is why the main measure for the prevention of peptic ulcer in children (stomach and duodenum) is compliance with hygiene standards.
It is important to remember that the bacterium is transmitted through saliva, because each member of the family must have separate toothbrushes and towels, it is worth paying special attention to this while the child is in school or kindergarten. Kisses between family members and acquaintances should be limited.
Additional activities
Additional measures for the prevention of peptic ulcer include the following:
- Dental treatment at the first manifestations of caries or toothache, since an unhealthy chewing apparatus cannot ensure thorough chewing of food, which leads to an increase in acidity in the stomach.
- A proper diet, that is, from the daily menu, you need to exclude fried, smoked and canned food, an abundance of flour products and carbonated drinks.
- Products should be subjected to a gentle heat treatment; preference should be given to steaming, boiling or baking in the oven at low temperatures, rather than smoking or frying.
- No stress, a relaxed lifestyle and a 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, carefully ground food is given. Products that increase the secretory function of the stomach are completely excluded from the diet. Dishes are served under salted.
The child should take food 6-8 times a day in small portions of approximately 200 grams. The range of permitted products includes:
- whole milk;
- butter and cream;
- soft boiled eggs;
- jelly and jelly from fresh, finely ground berries;
- light meat and vegetable broths;
Souffle from lean meats: beef, veal, rabbit, turkey, chicken and pork. Cream soups of vegetables and meat with the addition of rice or semolina.
As drinks, preference is given to a decoction of wild rose and chamomile, as well as sweet fruit and berry juices diluted in half with rice broth.
The temperature of the food should be in the range of 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 can not meet all the physiological needs of the child, because on the 3-4th day of treatment, the following are entered in the list of dishes:
- white bread (it should be slightly dried in the oven);
- cereals and soups in milk;
- meat and fish steaks, dumplings, meatballs and meatballs;
- in the absence of allergies, honey is used as an additional therapeutic agent, since it normalizes the secretory function of the stomach and promotes the healing of minor injuries in it.
According to clinical recommendations for peptic ulcer in children, mineral water heated to 45 degrees can be included as a drink, taken one hour before a meal.