Chronic Gastric Ulcers in Young Children: A Case Study

Q: Chronic Gastric Ulcers in Young Children: A Case Study

Hello： Based on your description, the low albumin and elevated eosinophils may indicate conditions other than parasites, such as eosinophilic gastroenteritis. <br>Patients with eosinophilic gastroenteritis can also be tested for IgE and allergens. <br>It is advisable to avoid foo

Chronic gastric ulcer

Hello Dr.
Fei, my child is 2 years and 10 months old.
On October 4th, he was hospitalized due to edema in the limbs and was found to have low albumin levels.
After an ultrasound examination, both the kidneys and liver were normal.
After receiving six high-protein infusions, his albumin level was restored to 3.1.
The physician could not determine the cause of the protein loss and suggested an endoscopy.
It was later discovered that he had a severe gastric ulcer, and there was abnormal dilation of the villi in the small intestine.
Once the pathology report came back, the diagnosis was chronic gastric ulcer, and he is currently undergoing treatment with gastric mucosa protectants.

The blood test results showed Eosinophils: 9.3, Eosinophil count: 1090, and WBC: 11.73.
Subsequently, he underwent six stool tests, all of which returned normal results.
However, the physician prescribed anti-parasitic medication for treatment.
During the sixth stool test, while he was on the anti-parasitic medication, no parasites or eggs were found.
Although the edema has improved, the child's abdomen still appears very distended, and his belly feels hard.

Could the abdominal swelling be related to the gastric ulcer and the condition of the intestines? Or should we investigate further for potential infection markers? I kindly request your response.
Thank you!

Mimiya, 30~39 year old female. Ask Date: 2012/10/19

Dr. Pei Rensheng reply Pediatrics

Hello: Based on your description, the low albumin and elevated eosinophils may indicate conditions other than parasites, such as eosinophilic gastroenteritis.
Patients with eosinophilic gastroenteritis can also be tested for IgE and allergens.
It is advisable to avoid foods that may trigger allergies, and medications (antihistamines or corticosteroids) can help manage the condition.
You are welcome to continue your treatment at the pediatric gastroenterology outpatient clinic.
Wishing you health and happiness! Sincerely, Dr.
Pei Ren-Sheng, Chief of Pediatrics, Taoyuan Hospital, Department of Health.

Reply Date: 2012/10/19

More Info

Chronic gastric ulcers in young children, particularly in a case like your 2-year-and-10-month-old child, can be a complex issue that requires careful evaluation and management. The symptoms and findings you've described, including low albumin levels, significant abdominal swelling, and the discovery of chronic gastric ulcers, suggest a multifaceted problem that may involve both gastrointestinal and systemic factors.

Understanding Gastric Ulcers in Children
Gastric ulcers are sores that develop on the lining of the stomach. In children, these can be caused by a variety of factors, including but not limited to:
1. Infection: The most common cause of gastric ulcers in older children and adults is infection with Helicobacter pylori (H. pylori). However, in younger children, this is less common. Your child's multiple stool tests for parasites and the absence of H. pylori in the biopsy are significant findings.

2. Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) and certain other medications can lead to gastric ulcers. If your child has been on any medications, this should be discussed with the healthcare provider.

3. Stress and Trauma: Psychological stress or physical trauma can contribute to the development of ulcers in children, although this is less well understood.

4. Dietary Factors: Certain dietary habits, such as high sugar or fat intake, may also play a role in gastrointestinal health.

5. Underlying Conditions: Conditions such as celiac disease or other gastrointestinal disorders can lead to malabsorption and subsequent complications, including ulcers.

Current Situation and Management
Given that your child has been diagnosed with chronic gastric ulcers and is currently undergoing treatment with a gastric mucosal protective agent, it is crucial to monitor the situation closely. The presence of abdominal swelling and hardness could be related to several factors:
- Gastric Distension: This may occur due to the ulcer itself, leading to inflammation and fluid accumulation in the abdomen.

- Malnutrition: Low albumin levels suggest that your child may not be absorbing nutrients properly, which can lead to edema and abdominal swelling.

- Potential Infection or Inflammation: Although initial tests have been normal, ongoing symptoms may warrant further investigation for infections or inflammatory conditions.

Recommendations
1. Follow-Up Testing: Given the persistence of abdominal swelling and hardness, it may be prudent to conduct further tests. This could include imaging studies like an abdominal ultrasound or CT scan to assess for any complications related to the ulcers or other gastrointestinal issues.

2. Nutritional Support: Since your child has experienced low albumin levels, consider working with a pediatric nutritionist to ensure that your child is receiving adequate nutrition. This may involve high-protein diets or supplements to help improve nutritional status.

3. Monitoring Symptoms: Keep a close eye on your child's symptoms. If there are any signs of worsening, such as increased pain, vomiting, or changes in bowel habits, seek immediate medical attention.

4. Consultation with Specialists: If the current treatment does not lead to improvement, consider consulting a pediatric gastroenterologist for a more specialized approach to your child's condition.

5. Emotional Support: Given the stress that chronic illness can place on both the child and the family, consider seeking support from a pediatric psychologist or counselor to help manage any emotional or psychological aspects of the illness.

Conclusion
Chronic gastric ulcers in young children can be challenging to manage, particularly when accompanied by systemic symptoms like edema and abdominal distension. A comprehensive approach that includes medical treatment, nutritional support, and careful monitoring is essential. Always communicate openly with your healthcare team about any concerns or changes in your child's condition to ensure the best possible outcomes.

Similar Q&A

Understanding Stomach Ulcers: Causes, Risks, and Concerns for Children

Hello Dr. Chen, I would like to ask you a few questions: Is the occurrence of a gastric ulcer considered a chronic disease? (Is there a hole in the stomach?) Can it develop within a month? Are children with Down syndrome more prone to developing it? What is the likelihood of a ...

Dr. Chen Zhiping reply Gastroenterology and Hepatology
Hello, ulcers are an acute condition. In adults, although medication can lead to healing (unlike diabetes or hypertension, which cannot be cured with medication), they are prone to recurrence. Therefore, while they are not classified as chronic diseases, many patients must underg...

Understanding Oral Ulcers in Children: Causes and Concerns

Hello doctor, my 8-year-old child has been experiencing continuous mouth ulcers for the past two weeks, and yesterday he developed an ulcer on the left side of his sublingual area. I applied an oral ointment, and this morning I noticed a small granulation tissue next to the ulcer...

Dr. Zheng Jueyi reply Otolaryngology
Hello, if oral ulcers persist without improvement, it is recommended to seek medical evaluation. Iron deficiency may be related to oral ulcers, and whether supplementation is needed should be assessed by a physician. Wishing you peace and health. Sincerely, Dr. Cheng Jue-Yi, Dire...

Understanding Persistent Diarrhea and Abdominal Pain in Children

Hello, my child is nine years old and is about to enter the third grade. She weighs 36 kg and has been experiencing diarrhea since early June. Additionally, she has persistent pain in the area just below her navel, which is tender to the touch. We have visited a major hospital an...

Dr. Xiao Kaiwen reply Pediatrics
Diarrhea lasting more than two weeks is referred to as chronic diarrhea. The most common cause is often due to damage to the intestinal mucosa following acute gastroenteritis, which may take time to recover, sometimes lasting 2-3 months or even up to six months. In such cases, me...

Understanding Antral Web in Children: Diagnosis, Treatment, and Resources

My child, around 5 months old, was diagnosed with antral web due to the presence of blood in the stool. After being hospitalized, the diagnosis was confirmed, and I found online that it refers to "a membrane in the gastric antrum." The doctor has suggested surgery. 1. S...

Dr. Pei Rensheng reply Pediatrics
Dear Xiao Wu, Hello! 1. You can find a lot of information by searching "antral web" on Google. 2. The literature suggests that surgical intervention is recommended, as medical treatment is ineffective. Wishing you health and happiness! Sincerely, Dr. Pei Renshe...