Peptic Ulcers

What Are Peptic Ulcers?

Peptic ulcers are open, painful sores that affect the stomach and the upper part of the small intestine, called the duodenum (doo-uh-DEE-num). Ulcers in the stomach are also called stomach ulcers or gastric ulcers. Those in the duodenum are also called duodenal ulcers. Peptic ulcers are rare in kids.

In the past, peptic ulcers could last for several years or even a lifetime. But a better understanding of what causes them and how to treat them means that most can be cured.

What Causes Peptic Ulcers?

Bacteria called Helicobacter pylori (or H. pylori) cause most peptic ulcers. Using common nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, also can cause a peptic ulcer. The ulcers form when the bacteria or the medicine weakens the mucus that coats the stomach and duodenum. This lets acid get through to the sensitive lining beneath. Both the acid and the bacteria can irritate the lining and cause an ulcer.

Some medical conditions also can play a role in ulcers. For example, illnesses that make it hard for the body to heal (such as serious burns from a fire) increase a child’s risk of ulcers. This is also true for infants who become septic (very ill with a bacterial infection). In otherwise healthy kids, peptic ulcers are very unusual.

What Are the Signs & Symptoms of Peptic Ulcers?

Signs of a peptic ulcer include:

• most commonly, burning pain in the belly between the breastbone and the belly button
• nausea
• vomiting
• chest pain (usually dull and achy)
• loss of appetite
• burping or hiccupping a lot
• weight loss
• feeding problems
• blood in vomit or bowel movements, which may look dark red or black

If your child has any of these signs and symptoms, call your doctor. Many can be caused by other childhood illnesses, but should be reported to your doctor. Based on your child's medical history and symptoms, the doctor may want your child to see a pediatric gastroenterologist. This is a doctor who treats problems of the stomach, intestines, and associated organs.

How Are Peptic Ulcers Diagnosed?

To look for peptic ulcers, doctors may:

• Order an upper gastrointestinal (GI) series. These X-rays of the esophagus, stomach, and duodenum let the doctor get a close look at the gastrointestinal tract. A person drinks a liquid called barium while getting the X-ray. If there’s an ulcer, it should be outlined on the X-ray.
• Do an upper endoscopy (en-DOSS-kuh-pee). The patient is sedated for this procedure. Then, the doctor puts an endoscope — a small, flexible tube with a tiny camera on the end — down the throat and into the stomach and duodenum. The doctors can see the lining of the esophagus, stomach, and duodenum to check for possible ulcers, inflammation, or food allergies. The doctor also can do tissue tests to check for H. pyloriIf there's any sign of inflammation, the doctor will test for H. pylori. This test is important because treatment for ulcers caused by H. pylori differs from treatment for those caused by NSAIDs.

To look for H. pylori, doctors can do:

• tissue tests during an endoscopy
•  stool tests to look for H. pylori antigens. Testing stool (poop) is becoming more common, as some doctors think they're more accurate than blood tests.
• breath tests, which can find carbon broken down by H. pylori after the patient drinks a solution. Breath tests are mostly done in adults.

How Are Peptic Ulcers Treated?

Most H. pylori-related ulcers can be cured. Treatment involves taking two kinds of antibiotics for 2 weeks and an acid suppressor (antacid) 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.

A child with an H. pylori-related ulcer should take all the antibiotics as directed by the doctor. Even if the symptoms stop, the infection may not be gone until your child takes all the medicine. Also, be sure to give your child the prescribed acid-reducing medicine.

To be sure the treatment worked, doctors may order a stool test to see if the H. pylori bacteria are gone. If symptoms last or get worse, doctors might do a follow-up endoscopy in 6 to 12 months to check for H. pylori.

Ulcers from NSAID use rarely need surgery and usually get better with an acid suppressor and stopping or changing the NSAID. Because bacteria are not involved, antibiotics can’t treat this type of ulcer. Kids who get a medicine-related ulcer should avoid NSAIDs and any medicines that contain ibuprofen or aspirin.

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

Can Peptic Ulcers Be Prevented?

Regular 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.

Alcohol and smoking can make an ulcer more likely. Help your child avoid coffee, tea, sodas, and foods that contain caffeine, which can increase acid in the stomach and may make an ulcer worse.

When Should I Call the Doctor?

Call the doctor right away if your child has any of these symptoms:

• sudden, sharp, lasting belly pain
• bloody or black bowel movements (poop)
• bloody vomit or vomit that looks like coffee grounds

These could be signs of a serious problem for a child who’s had a peptic ulcer, such as:

• perforation (when the ulcer gets 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 takes NSAIDs and shows signs of a peptic ulcer, get medical help right away. Delaying diagnosis and treatment can lead to more problems and, possibly, the need for surgery. But with quick treatment, almost all peptic ulcers can be cured.