Stomach and Duodenal Ulcers in Children

What is a stomach or duodenal ulcer in children?

An ulcer is an open sore (lesion). It’s normally found on the skin or mucous membranes.

A peptic ulcer is in the lining of the stomach or the first part of the small intestine (the duodenum). A gastric ulcer is in the stomach. A duodenal ulcer is in the duodenum.

What causes stomach and duodenal ulcers in a child?

Experts used to think that stress, diet, and stomach acid caused ulcers. Today, research shows that most ulcers form because of an infection with a germ (bacteria) called Helicobacter pylori (H. pylori). Other things play a role, but this bacteria is often the main cause of most ulcers.

These things may play a role in stomach or duodenal ulcers:

• H. pylori. These bacteria make substances that weaken the protective mucus in your child’s stomach. This makes it more likely to get damaged from acid and pepsin.
• Smoking. Studies show smoking increases the chances of getting an ulcer. It also slows the healing process of ulcers and causes ulcers to come back.
• Caffeine. Caffeine may cause the stomach to release acid. This may make the pain of an existing ulcer worse. However, it does not cause ulcers.
• Stress. Emotional stress is no longer thought to cause ulcers. But people with ulcers often say that their stress increases ulcer pain. Physical stress may increase the risk for ulcers, especially in the stomach. For instance, people with injuries, such as burns, and people who have major surgery often need treatment to prevent ulcers and ulcer complications.
• Acid and pepsin. The stomach can’t always fully defend itself against strong digestive fluids. These include hydrochloric acid and pepsin. This may cause ulcers to form.
• Nonsteroidal anti-inflammatory drugs (NSAIDs). These medicines make the stomach more likely to be harmed by acid and pepsin. These medicines include aspirin, ibuprofen, and naproxen. These ingredients are in many over-the-counter medicines. They're used to treat fever, headaches, and pain.

Which children are at risk for stomach and duodenal ulcers?

The greatest risk factor for gastric and duodenal ulcers is an H. pylori infection. Things that make an H. pylori infection more likely include:

• Living in overcrowded conditions
• Sharing a bed
• Genetics (children with Hispanic and African-American backgrounds have a higher risk)

Children who regularly take aspirin or NSAID pain relievers are also at risk for ulcers.

In rare cases, other medical conditions can cause ulcers in children.

What are the symptoms of stomach and duodenal ulcers in a child?

Ulcers don’t always cause symptoms.

The most common symptom is a gnawing or feeling of burning pain in the stomach. This is often felt between the breastbone and the belly button (navel). Your child may feel the pain more between meals, in the early morning, or at night. It may last from a few minutes to a few hours.

Less common ulcer symptoms include:

• Anemia
• Bloating
• Belching
• Nausea and vomiting
• Vomit with blood in it
• Poor appetite
• Weight loss
• Tiredness and weakness
• Red or maroon stool or black, tarry stool

The symptoms of ulcers may look like other health problems. Make sure your child sees their healthcare provider for a diagnosis.

How are stomach and duodenal ulcers diagnosed in a child?

Your child’s healthcare provider will ask about their health history. They will also give your child an exam. Your child may need more tests before their ulcer is diagnosed.

Upper GI (gastrointestinal) series

This test looks at the organs in the upper part of your child’s digestive system. For this test, your child will swallow barium. This is a silvery, white, chalky liquid that coats the inside of your child's organs. This helps them show up on an X-ray better. Then the provider will take an X-ray of these organs.

Endoscopy

In this test, a small, flexible tube (endoscope) is used to look at the inside of your child’s digestive tract. This tube has a light and a camera lens at the end of it. During the test, the healthcare provider may take tissue samples from your child's digestive tract. The provider will test these samples.

Blood, stool, breath, and stomach tissue tests

These tests are done to look for H. pylori.

How are stomach and duodenal ulcers treated in a child?

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.

Your child's treatment will also depend on what’s causing the ulcer. For instance, ulcers caused by H. pylori need different treatment from ulcers caused by using NSAIDs.

Lifestyle changes

In the past, healthcare providers told people with ulcers to not eat spicy, fatty, or acidic foods. Providers now know this type of diet doesn’t cause ulcers. But it may cause symptoms to become worse. There has not been a specific diet that has been shown to help people with ulcers. If it seems that certain foods make your child’s ulcer worse, talk with their provider.

Some children and teens smoke cigarettes. Parents don’t always know that their children smoke. Smoking slows the healing process of ulcers and causes ulcers to come back. If your child or teen drinks alcohol, they should stop to help the ulcer heal.

Medicines

Your child may need to take medicine. If your child has H. pylori, they may need more than 1 medicine. Medicines used to treat ulcers include:

• Antibiotics. These medicines kill bacteria.
• H2-blockers. These medicines reduce the amount of acid the stomach makes. They do this by blocking histamine, which causes acid to be released.
• Proton pump inhibitors. These medicines block stomach acid production. They work by stopping the stomach's acid pump. This is the last step of acid secretion.
• Mucosal protective agents. These medicines protect the stomach's mucous lining from the damage of acid. They don’t stop acid from being released.

Surgery

Most of the time, medicine heals ulcers and they don’t come back. In rare cases, people don’t respond to lifestyle changes and medicine. Then they may need surgery.

What are possible complications of stomach and duodenal ulcers in a child?

Your child could have severe complications if their ulcer isn’t treated well. The most common problems include:

• Bleeding. An ulcer can harm blood vessels. This can cause bleeding.  
• Hole (perforation). An ulcer can wear a hole through the wall of the stomach or duodenum. Bacteria and partially digested food can spill through the opening into the abdominal cavity (peritoneum). This is a serious condition called peritonitis. This is inflammation of the abdominal cavity and wall.
• Narrowing and blockage (obstruction). Ulcers at the end of the stomach where the duodenum is attached can cause swelling and scarring. This can narrow or close the intestinal opening. This blockage can stop food from leaving the stomach and going into the small intestine. This can cause vomiting.
• Stomach cancer. H. pylori infection increases the risk for stomach cancer later in life.

What can I do to prevent stomach and duodenal ulcers in my child?

Preventing H. pylori can reduce your child’s risk of ulcers. It isn’t fully understood how this infection is spread. But these things may lower your child’s risk of H. pylori:

• Washing hands often
• Not having close contact with someone who has H. pylori
• Not eating or drinking contaminated food or water

Ask your child's provider about alternatives to aspirin or NSAID pain relievers for your child.

How can I help my child live with stomach and duodenal ulcers?

Most people with stomach ulcers are cured with treatment. Work with your child’s healthcare provider to make a care plan for your child. If your child is treated for H. pylori bacteria, they will have a test after treatment to confirm that the bacteria is gone.

When should I call my child's healthcare provider?

Call your child’s provider if your child has signs of an ulcer. These include a gnawing or burning pain in their stomach that happens between or after meals, in the morning, or late at night. Signs may also include lasting nausea or vomiting. If your child has black, tarry stool or significant rectal bleeding, contact the provider or go to the emergency room.

Key points about stomach and duodenal ulcers in children

• Stomach and duodenal ulcers are open sores. They happen in the lining of the stomach or the duodenum.
• Most ulcers are caused by an infection with H. pylori.
• Treatment often includes antibiotics and medicines to block stomach acid production.
• Without the right treatment, people with ulcers may have serious complications. But most people are cured with treatment.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

• Know the reason for the visit and what you want to happen.
• Before your visit, write down questions you want answered.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are and when they should be reported.
• Ask if your child’s condition can be treated in other ways.
• Know why a test or procedure is advised and what the results could mean.
• Know what to expect if your child does not take the medicine or have the test or procedure.
• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.