소아의 소화성 궤양에 관한 임상적 고찰

Abstract

[한글]

[영문]

Peptic ulcer is a frequently encountered problem in the adult, but relatively rare in infancy and childhood. With the improvement of diagnostic aids(particularly radiologic equipment), peptic ulcers have been detected with increasing frequency. However, there is a paucity of information available concerning this disease in infancy and childhood in Korea. Psychologic problems are an important etiologic factor of peptic ulcer in childhood especially in a complicated, specialized, and

civilized society.

The author clinically observed 33 patients with peptic ulcer, under the age of 15 years, who were admitted to the Department of Pediatrics at Severance Hospital from Sept., 1956 to Aug., 1971.

The age and sex incidence, type and location of ulcer, etiologic factors, clinical and laboratory findings, complications, treatment and prognosis were analyzed and the data is summarized as follows;

1. The incidence of peptic ulcer in childhood was 0.32% of a total 10.585 admissions, and the average number of patients of peptic ulcer per year was 2.2.

2. Sex incidence showed that males predominated in a proportion of 3.1 : 1.

The ratio of male to female was 1.6 : 1 from newborn to 6 years of age but 4:1 between the ages of 7 and 15.

3. Among 33 patients, 13 cases(39.4%) were between 12 and 15 years of age, and 12 patients(36.4%) between 7 and 11, and so the majority(75.8%) were between the ages of 7 and 15. The youngest patient was a 3 month old female infant who died of gastric perforation.

4. The incidence of ulcer site was 9 cases(24.3%) of gastric and 29 cases(75.7%) of duodenal including gastroduodenal ulcers. The ratio of gastric to duodenal ulcer was 1:3.2.

In gastric ulcer females were predominant 3 times greater than males, but in duodenal ulcer, males were predominant 5 times greater than females. In gastroduodenal ulcers which occurred over 7 years of age, males predominated 4 times greater than females. There was no difference in the age distribution of

gastric ulcer, but the incidence of duodenal ulcer increased in the older age group. The occurrance of peptic ulcer between 7 and 15 years was 3 times more frequent than the age group under 6 years.

5. Probable etiologic factors were identified in 13 of the 33 patients:

psychologic problem, 9: drug(P.A.S.), 1; severe infection(septicemia due to empyema), 1; head trauma, 1;Henoch-Schoenlein purpura, 1.

But in 19 patients, the etiologic factors could not be found.

6. The majority(70%) had abdominal pain which was not related to meals. Other symptoms were nausea(42.3%), vomiting(36.3%), indigestion(36.3%), pallor and lethargy(30.0%). melena(30.0%), hematmesis(24.2%), anorexia(15.1%), diarrhea(15.1%), constipation(9.0%), dyspnea(9.0%), and abdominal distension(9.0%).

7. Gastric analysis was performed in 19 patients; 17 of these patients had hyperchlorhydria, but 2 cases had hypo- or achlorhydria.

8. Complications were found in 19 patients(57.6%). They were gastrointestinal bleeding, 15(45.4%), partial obstruction, 2(6.0%), and perforation, 2(6.0%). The majority of patients had moderate to sever anemia, and immediate blood transfusion was necessary in the 30.2% of the 33 patients who had Hb levels below 7.0 gm/%.

9. Among the total 33 patients, ulcer symptoms disappeared in 19 patients with medical treatment such as antacids, tranquilizers and other conservative treatment. One patient died of gastric ulcer perforation. Nine patients improved with combined psychological and medical treatment. Operations were performed in 4 patients who had sever complications such as hemorrhage, perforation or partial obstruction.

10. Reccurrance was found in 2 patients: one is 7 months after initial episode, and another is 8 months later.