Stress Duodenal Ulcer Presenting as Hematochezia in a Neonate
Primary duodenal ulcers are very rare in children under 10 years of age but stress induced ulceration in the stomach occurs more often in the neonatal period due to birth asphyxia, prolonged labour, caesarean deliveries, instrumentations, respiratory distress syndrome and sepsis. These present as acute onset of gastrointestinal bleed commonly as altered gastric aspirate, hematemesis or melena.
Management of a neonate with stress ulcer presenting as hematochezia
Upper Gastrointestinal Endoscopy (UGIE) done which revealed a large ,clean based ulcer in the antero-superior wall of the first part of the duodenum. Child was treated with lansoprazole.
The use of lansoprazole resulted in the complete healing of the ulcer after 7 days of the therapy.
Stress peptic ulcers should be suspected in a neonate presenting with massive gastrointestinal bleeding after difficult delivery and birth asphyxia. UGIE is mandatory to rule out lesions bleeding from stomach or duodenum or both.
Rowland M, Bourke B, Drumm B Helicobacter pylori and peptic ulcer disease. In: Klienman, Goulet, Mieli-Vergani. Walker's Pediatric Gastro-intestinal Disease. 5th 4ed. Ontario: BC Decker Inc; 200p.139-151. Mezoff AG, Balistreri WF. Peptic ulcer disease in children. Pediatr Rev.1995; 16: 257-2
Shuman RS, Schuster DP, Zukerman Prophylactic therapy for stress ulcer bleeding: a reappraisal. Ann Intern Med. 1987; 106:562-567.
Johnson D, L’heure P. Peptic ulcer disease in early infancy: clinical presentation and roentgenographic features. Acta Paediatr Scand. 1980; 69: 753-760.
Ruuska T, Fell JME, Bisset WM and Milla PJ. Neonatal and infantile upper gastrointestinal endoscopy using a new small diameter fibreoptic gastroscope. J Pediatr Gastroenterol Nutr. 1996; 23: 604-608. Hsu HY, Chang MH. Acute duodenal ulcer. Arch Dis Child.1989; 64:774-s779. Guthrie KJ. Peptic ulcer in infancy and childhood with a review of the literature. Arch Dis Child.1942; 17: 84-94.
Sarna MS, Saili A, Dutta AK, Sharma D. Stress associated gastric bleeding in newborn role of ranitidine. Indian Pediatr. 1991; 28:1305-1308.
Tighe MP, Afzal NA, Bevan A, Beattie RM. Current pharmacological management of gastroesophageal reflux in children: an evidence-based systematic review. Paediatr Drugs. 2009; 11:185-202.