Endoscopic «findings» in children with duodenal ulcer

Abstract

Objectives: to analyze the nature of polypoid formations of the esophagus and stomach, endoscopically detected in children with duodenal ulcer (DU). Methods. For 5 years, 296 children aged 6 to 18 years with duodenal ulcer were under a single-center study. The diagnosis was verified fibrogastroscopically, determination of Hp infection, and morphological examination. The results were statistically processed. Results. Polypoid formations were detected in 24 children (8.2%) with duodenal ulcer. Most of polyps (67%) were localized in antrum and prepyloric areas (Fig.1) and turned out to be "endoscopic findings". Their wide base size usually did not exceed 1 cm; hemispherical, papillary or cylindrical in shape with a smooth surface were single. Morphologically, most of these polyps were hyperplastic, in 3 patients - adenomatous. In 5 children, endoscopy revealed signs of choristoma, confirmed morphologically, and in 2 children with ulceration. In 7 older children with a long history of ulcers, polypoid formations were determined in the lower (Fig.2) and middle third of the esophagus. They were formed at the site of erosions and ulcers of the esophagus as a variant of incomplete healing with hyperplastic growths (Fig.3) and subsequent formation of Barrett's esophagus. Morphologically, 3 children were diagnosed with squamous papilloma (lower third), in 2 – areas of gastric metaplasia – Barrett's esophagus, in 2 – leiomyoma of the middle third of the esophagus. Unlike gastric localization, polypoid formations in the esophagus were accompanied by patients complaints and a clinical picture of complicated GERD. Conclusions. Polypoid formations of the upper digestive tract are detected in 8.2% of duodenal ulcers. Such changes acquire unfavorable development in the esophagus in patients with a combination of DU and severe GERD.