Peptic Ulcer Disease in Pediatrics: A Comprehensive Review.

Peptic ulcer disease (PUD) in children, while less prevalent than in adults, poses significant diagnostic and therapeutic challenges because of age-specific presentations and pathophysiology. This review addresses the epidemiology, etiologies, clinical manifestations, and management strategies of pediatric PUD, with particular emphasis on Helicobacter pylori-associated and non-H pylori ulcers. The review outlines the limitations of applying adult-based "test-and-treat" strategies to children and underscores the importance of guideline-directed endoscopic evaluation and targeted therapy. The review also explores emerging antibiotic resistance patterns, appropriate use of acid therapy, and follow-up protocols to confirm H pylori eradication. Distinct pediatric considerations, including age-appropriate diagnostics, medication dosing, and caregiver education, are discussed. Additionally, the review presents updated guidance from the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and European Society for Paediatric Gastroenterology Hepatology and Nutrition to aid clinicians in tailoring care. By synthesizing recent advances and best practices, this review aims to enhance recognition, reduce inappropriate testing, and improve outcomes in children affected by PUD.