Treatment outcomes and determinants of refractory peptic ulcer disease in children: A prospective study from Vietnam

OBJECTIVE: To evaluate treatment outcomes of pediatric peptic ulcer disease (PUD) and to identify determinants of refractory ulcers, with emphasis on Helicobacter pylori (H. pylori) status. METHODS: In this prospective study, 254 children (2-17 years) with endoscopically confirmed ulcers were enrolled at a tertiary center in Vietnam (2023-2024). H. pylori status and eradication were assessed according to ESPGHAN/NASPGHAN guidelines. Ulcer healing was evaluated at 6 weeks, with repeat endoscopy at 12 weeks for patients with persistent ulcers. Refractory PUD was defined as persistence of active or healing-stage ulcers at 12 weeks. Multivariable logistic regression was used to identify factors associated with refractory disease. RESULTS: Healing rates were 65.7% at 6 weeks and 76.4% at 12 weeks, and 23.6% of patients had refractory PUD. Healing rates did not differ according to H. pylori status. Eosinophilic gastritis was more frequent in refractory cases, particularly among H. pylori-negative patients. On multivariable analysis, eosinophilic gastritis (adjusted odds ratio [aOR] 6.12; 95% confidence interval [CI] 2.47-15.15), persistent H. pylori infection (aOR 4.04; 95% CI 1.67-9.76), and poor treatment adherence (aOR 8.12; 95% CI 3.69-17.87) were independently associated with refractory ulcers. CONCLUSIONS: Nearly one-quarter of children had delayed or incomplete ulcer healing at 12 weeks. Eosinophilic gastritis, persistent H. pylori infection, and poor treatment adherence were independently associated with refractory ulcers, supporting risk stratification and closer follow-up.