Hung often had stomach pain that resolved on its own. However, for the last two weeks, the pain intensified, accompanied by belching, heartburn, indigestion, vomiting, and black sticky stools. Endoscopy results revealed Hung had gastroduodenal ulcers, with multiple lesions measuring 5-7 mm.

Master, Doctor, Level I Specialist Hap Tien Loc from the Pediatrics Department at Tam Anh General Clinic, District 7, noted that Hung was pale and fatigued due to anemia. The black sticky stools indicated that blood had been digested by gastric acid and intestinal bacteria. This condition led to gradual blood loss, making the patient's condition worse. The two co-existing conditions exacerbated the illness and increased the risk of complications.

Doctor Loc explained that a duodenal ulcer involves damage to the blood vessels in the intestinal lining, causing gastrointestinal bleeding. In children already suffering from anemia, with naturally low hemoglobin levels, even minor bleeding from the ulcer can quickly lead to hypotension and rapid hypovolemic shock.

Children with both conditions respond to treatment with difficulty. For the duodenal lining ulcer to heal, the body requires adequate oxygen and nutrients to reach the affected area. Anemia reduces the blood's oxygen-carrying capacity, slowing down the mucosal recovery process.

Additionally, the child needed iron supplementation for anemia. However, oral iron supplements often irritate the gastroduodenal lining, causing heartburn, abdominal pain, and nausea, which could worsen the child's stomach pain symptoms. Yet, treating only the ulcer without iron supplementation would not improve anemia, leading to weakened immunity.

Doctor Loc prescribed proton pump inhibitors (PPIs) by injection for Hung for about 4 weeks. This aimed to strongly suppress acid, maintain stable stomach pH, help control bleeding, and promote faster ulcer healing, combined with antibiotics. During medication, the patient needed follow-up appointments as directed to monitor symptoms. The child was advised to avoid sour, spicy, and carbonated foods, coffee, and to reduce stress.

After one week, the child's abdominal pain subsided, belching stopped, and appetite improved. Upon completion of the current medication course, Hung is expected to be prescribed iron supplements to treat anemia, preventing further impact on his digestive system.

A doctor performs an endoscopy on a child with a duodenal ulcer. Photo: Tam Anh General Clinic, District 7

A duodenal ulcer is a condition where the duodenal lining is damaged, leading to open sores. The disease is often caused by Helicobacter pylori (HP) bacteria, transmitted through food and drink, sharing eating utensils, or poor hygiene. Some children develop the condition due to excessive use of fever reducers and pain relievers, which erode the protective mucosal layer, or because of a family history of gastroduodenal ulcers.

Common symptoms include epigastric pain when hungry or at night, nausea, bloating, heartburn, and loss of appetite. If a child vomits blood or brown liquid resembling coffee grounds, or passes black or fresh bloody stools, these are warning signs of ulcer bleeding, requiring immediate medical attention. Untreated duodenal ulcers can lead to gastrointestinal hemorrhage, duodenal perforation causing peritonitis (a surgical emergency), or pyloric stenosis, resulting in frequent vomiting, weight loss, and malnutrition.

In cases where a child has a duodenal ulcer with underlying anemia, like Hung, the risk of hypovolemic shock is higher than normal. Children need to be examined to determine the exact cause, and medication should not be used without a doctor's prescription.

To prevent the condition in children, Doctor Loc advised parents to ensure children eat cooked food, drink boiled water, and have small, frequent meals. They should avoid sour, spicy, greasy fried foods, and sugary carbonated drinks. Good hand and utensil hygiene is essential to prevent HP bacteria transmission. Children should get enough sleep, rest adequately, and avoid academic pressure and stress. If a child experiences persistent abdominal pain of unknown cause, they should be taken for immediate medical examination.

Dinh Lam

*Patient's name has been changed