March Week 1 ( by Dr Dixon)
Peptic Ulcer Disease: PIR. Chelminsky. Czinn. 2001.
Helicobacter Pylori. PIR. Rosenberg. 2010
A 5 year old male is brought in by his mother for 2 months of “belly
pain.” It occurs daily, she says, and happens multiple times a day,
sometimes associated with eating, other times completely unrelated.
The pain causes the patient to cry and be very irritable at times.
Initially mom thought it was behavioral, so she didn’t seek medical
attention. Now, the patient will occasionally awaken from sleep with
the pain. The patient’s appetite is more or less unchanged, Mom also notes a lot of belching/hiccuping recently, which she thinks is
unusual. The patient points and says the pain is “right in the
middle.” On exam, VSS. He appears comfortable, and his exam is
reassuring except for tenderness in the periumbilical area to very
1) What further history would you try to elicit from this mother and
the patient? Do the symptoms cound as “Dyspepsia” as outlined in the
article (Table 1)?
2) Mom asks about “H. pylori.”. She has heard this can be very bad
and cause “cancer.” She wants to know if we should test for it,
perhaps a “breath test”, she says, What do you say? What is the most
4) What is the AAPs standpoint on when testing for H. Pylori
infection is indicated?
5) What is the treatment for H. Pylori? When should the child be
re-checked for eradication?
6) Should this child undergo endoscopy now?