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To the Editor:—
I appreciate the letter from Dr. Keeffe concerning the difficulties in the diagnosis of peptic ulcers in children. I am aware of the difficulty, since I have been working with this problem for 11 years. The four radiologists on the staff of my clinic are experienced in pediatric radiology. Our radiology residents spend a portion of their time in pediatric radiology at Childrens' Hospital, in Cincinnati. A diagnosis of peptic ulcer is not made unless an ulcer crater can be demonstrated. To minimize exposure of the patient, the fluoroscopic time is sharply limited and reliance is placed on multiple spot films in various projections, including double-contrast examination of the duodenal bulb. Ordinarily, 8 to 12 spot films and 4 roentgenograms are taken during the stomach examination. The best detail is obtained with use of water-soluble contrast agents.In the last 11 years, over 90 pediatric peptic ulcers
Tudor RB. PEPTIC ULCERS IN CHILDREN. JAMA. 1960;172(8):852. doi:10.1001/jama.1960.03020080082026