Population	Features
Children	Incidence: Rare; most ulcers occur between eight and 17 years of age; duodenal ulcer up to 30 times more common than gastric ulcer
	Cause: Helicobacter pylori infection contributory
	Presentation: Patients may present with poorly localized abdominal pain
	Testing: EGD should be performed if ulcer suspected; test- and-treat strategy not recommended; H. pylori testing and treatment recommended only if ulcer is documented by EGD or contrast studies
	Treatment: Antisecretory agents
	Complications: 25 percent of bleeding duodenal ulcers may be silent; perforation and penetration rare
Older patients	Presentation: More likely to have painless ulcers; 50 percent present acutely (e.g., with perforation); may present with nonspecific complaints (e.g., confusion, restlessness, abdominal distention, fall)
	Complications: Perforations associated with mortality three times higher than in younger patients; hemorrhagic complications more likely (20 percent from silent ulcers); more likely to have continued bleeding and to need transfusions and surgery
Patients with stress ulcers	Cause: Breakdown of mucosal protectants as a result of stress leads to splanchnic hypoperfusion and ulcer; risk factors include mechanical ventilation longer than 48 hours, burns, coagulopathy, moderate to severe trauma, head or spinal cord injury, liver failure, and organ transplantation
	Presentation: Patients may be asymptomatic or may develop bleeding or perforation
	Treatment: Early institution of PPI prophylaxis with oral or intravenous pantoprazole (Protonix) minimizes ulcer risk; histamine H2 blockers and sucralfate (Carafate) are other options for prophylaxis
Pregnant women	Presentation: Ulcer symptoms milder and may improve during pregnancy; vomiting is nocturnal or postprandial and worse in third trimester
	Testing: Ultrasonography and EGD are safe diagnostic tests
	Treatment: Early, aggressive treatment with PPI recommended; misoprostol (Cytotec) contraindicated; H. pylori infection treated as usual; avoid tetracyclines throughout pregnancyand metronidazole (Flagyl) during first trimester
	Complications: Infrequent; hypotension treated vigorously to minimize placental hypoperfusion; risk of miscarriage, abruption, and preterm labor if complications ensue