Peptic Ulcers

About Peptic Ulcers

An ulcer is a sore, which means it's an open, painful wound. Peptic ulcers are ulcers that form in the stomach or the upper part of the small intestine, called the duodenum. An ulcer in the stomach is called a gastric ulcer and an ulcer in the duodenum is called a duodenal ulcer.

Both a gastric ulcer and a duodenal ulcer result when H. pylori or a drug weakens the protective mucous coating of the stomach and duodenum, allowing acid to get through to the sensitive lining beneath. Both the acid and the bacteria can irritate the lining and cause an ulcer to form.

H. pylori infection is usually contracted in childhood, perhaps through food, water, or close contact with an infected individual. Infections are more common in adults older than age 60 and in developing countries. And most people with H. pylori don't display any symptoms until they're older. In fact, they may go through life unaware that they're infected.

Although H. pylori infection usually doesn't cause problems in childhood, if left untreated it can cause gastritis (the irritation and inflammation of the lining of the stomach), peptic ulcer disease, and even stomach cancer later in life.

In the past, having peptic ulcers meant living with a chronic condition for several years or even a lifetime. But today, a better understanding of the cause of peptic ulcers and how to treat them means that most people can be cured.

Causes of Peptic Ulcers in Kids

Although stress and certain foods may aggravate an ulcer, most ulcers are caused by an H. pylori infection or the use of common nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen.

However, whereas most experts agree that H. pylori infection is a primary cause of peptic ulcers in adults, not everyone thinks that the bacteria are a major culprit in childhood ulcers. Some doctors make the distinction between duodenal ulcers, which are commonly associated with H. pylori infection, and gastric ulcers, which may stem from other causes.

It's recognized that certain medical conditions can contribute to the development of ulcers. For instance, children with severe burns can develop ulcers secondary to the stress of their injuries. This is also true for infants who become septic, or very ill with a bacterial infection. In otherwise healthy kids, peptic ulcers are very unusual.

Some doctors believe that more kids get drug-related gastric ulcers than other types of peptic ulcers. Even moderate use of NSAIDs can cause gastrointestinal problems and bleeding in some children. Acetaminophen does not cause stomach ulcers and is a good alternative to NSAIDs for most childhood conditions.

Signs and Symptoms

Although peptic ulcers are rare in kids, if your child has any of the following signs and symptoms, call your doctor:

• burning pain in the abdomen between the breastbone and the belly button (the most common ulcer symptom)
• nausea
• vomiting
• chest pain (usually dull and achy)
• loss of appetite
• frequent burping or hiccuping
• weight loss
• feeding difficulties
• blood in vomit or bowel movements, which may appear dark red or black

These signs and symptoms are common in many childhood illnesses and don't necessarily indicate an ulcer, but they should be reported to your doctor. Based on your child's medical history and symptoms, the doctor may refer your child to a pediatric gastroenterologist (a doctor who specializes in disorders of the stomach, intestines, and associated organs) for further evaluation.

Diagnosis

The doctor may do an upper gastrointestinal (GI) series to get a close look at your child's gastrointestinal tract. An upper GI series is a set of X-rays of the esophagus, stomach, and duodenum.

The doctor may also order an upper endoscopy, especially if an ulcer is suspected. This procedure, performed under sedation, involves inserting an endoscope — a small, flexible tube with a tiny camera on the end — down the throat and into the stomach and duodenum. It lets the doctor see the lining of the esophagus, stomach, and duodenum to check for possible ulcers, inflammation, or food allergies. It also can be used to perform tissue tests to check for H. pylori.

The endoscopy is sometimes used with a test called a pH probe in which a small wire is inserted into the lower part of the esophagus to measure the amount of acid going into that area.

If there's any evidence of inflammation, the doctor will test for H. pylori. This test is important because treatment for an ulcer caused by H. pylori is different from the treatment for an ulcer caused by NSAIDs.

H. pylori may be diagnosed through:

• tissue tests (performed during an endoscopy)
• blood tests (which can detect the presence of H. pylori antibodies; blood tests are easy to perform, although a positive test may indicate exposure to H. pylori in the past and not an active infection)
• stool tests (which can detect the presence of H. pylori antigens; stool tests are becoming more common for detecting H. pylori, and some doctors think they're more accurate than blood tests)
• breath tests (which can detect carbon broken down by H. pylori after the patient drinks a solution; breath tests are also used mostly in adults)

Treatment

The good news is that most H. pylori-related ulcers are curable with treatment that combines two different kinds of antibiotics and an acid suppressor. The antibiotics are taken over a 1- to 2-week period and the antacid is given for 2 months or longer. The ulcer may take 8 weeks to heal, but the pain usually goes away after a few days or a week.

To be sure the treatment has worked, doctors may order a stool test to verify the absence of H. pylori. If symptoms persist or worsen, doctors might do a follow-up endoscopy 6 to 12 months later to check for H. pylori.

Likewise, ulcers related to NSAIDs rarely require surgery and usually improve with an acid suppressor and stopping or changing the NSAID. No antibiotics are needed to treat this type of ulcer.

Caring for Your Child

If your child is diagnosed with an H. pylori-related ulcer, make sure he or she takes all of the antibiotics as directed by the doctor. Even if the symptoms disappear, the infection may not be gone until all of the medication has been taken.

If your child has a medication-related ulcer, the doctor will tell you to avoid NSAIDs, including any medication containing ibuprofen or aspirin. Also, be sure to give your child the prescribed acid-reducing medication.

Unless a particular food is bothersome, most doctors don't recommend dietary restrictions for kids with ulcers. A good diet with a variety of foods is essential to all kids' growth and development.

Alcohol and smoking can aggravate an ulcer. Also make sure that your child avoids coffee, tea, sodas, and foods that contain caffeine, which can stimulate the secretion of acid in the stomach and may make an ulcer worse.

When to Call the Doctor

Call your child's doctor immediately if your child has any of these symptoms:

• sudden, sharp, persistent belly pain
• bloody or black bowel movements
• bloody vomit or vomit that looks like coffee grounds

If your child has peptic ulcer disease, these signs and symptoms could indicate a serious problem, such as:

• perforation (when the ulcer becomes too deep and breaks through the stomach or duodenal wall)
• bleeding (when acid or the ulcer breaks a blood vessel)
• obstruction (when the ulcer blocks the path of food from going through the intestines)

If your child is taking NSAIDs and shows symptoms of peptic ulcer disease, seek prompt medical attention. Delaying diagnosis and treatment can lead to complications and possibly the need for surgery. But with timely treatment, almost all peptic ulcers can be cured.

Reviewed by: Michael K. Davis, MD
Date reviewed: July 2009