Stomach (Peptic) Ulcers in Children

Symptoms, Causes, Diagnosis, and Treatment

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Child not feeling well enough to eat
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Peptic ulcers, also known as stomach ulcers, are less common in children than adults but occur more frequently than one might imagine. According to 2011 research published in the medical journal Ulcers, as many as 8.1 percent of children in Europe and 17.4 percent in the United States will experience a peptic ulcer before the age of 18.

While peptic ulcers are closely related to a bacteria known as Helicobacter pylori (H. pylori), they are sometimes secondary to more a serious disease, such as cancer. Diagnosis in children differs slightly from adults as some tests are less able to deliver reliable results. Uncomplicated cases are usually easily treated with antibiotics and other oral medications.

Unless there is a serious underlying cause, the risk of complications from a peptic ulcer is low (between 1 percent and 2 percent) and the risk of death even lower (0.001 percent).

Symptoms

A peptic ulcer is simply an open sore that develops on the lining of the stomach. A sore in the stomach itself is referred to as a gastric ulcer, while one that develops further along toward the small intestine is called a duodenal ulcer.

The common signs of a stomach ulcer include:

  • A dull burning or gnawing ache in the stomach
  • Gas and bloating
  • Nausea or vomiting
  • Loss of appetite
  • Fatigue

While the pain is often most noticeable when the stomach it is empty, the reactive pain that occurs after eating can often distinguish a gastric ulcer from a duodenal one. Gastric ulcers will usually cause pain soon after food is eaten, while the pain from a duodenal ulcer will usually only develop two or three hours later.

An ulcer can be considered severe if the pain is sharp and specific rather than dull and aching. This may be an indication that the ulcer is bleeding, a condition often accompanied by bloody or tarry stools or the vomiting of blood or coffee-like particles.

Fever, chills, vomiting, and difficulty swallowing are all signs of a condition requiring urgent medical care.

Complications of a peptic ulcer may include malnutrition, gastric perforation, and bowel obstruction (caused by inflammation of the duodenum). Both an obstruction and perforation are considered medical emergencies requiring immediate attention.

Causes

H. pylori is a corkscrew-shaped bacterium commonly linked to chronic gastritis and peptic ulcers. Around 50 percent of the world’s population is believed to have H. pylori, 20 percent of whom will develop upper gastrointestinal symptoms.

While H. pylori is a common cause of peptic ulcers in children, other factors may either cause or contribute to their development. Among them:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen are independently associated with gastric bleeding and ulcers when overused.
  • Genetics is believed to play a role, as around 20 percent of children will have a family history of peptic ulcers.
  • Extremely stressful events can trigger ulcers in both children and adults, manifesting with acute symptoms within three to six days. Examples include a major life trauma, injury, infection, or surgery.
  • Obesity is associated with an increased risk of pediatric ulcers, spurred by increased gastrointestinal inflammation and changes in the normal bacterial flora.
  • Gastroesophageal reflux disease (GERD) is characterized by chronic acid reflux which in severe cases can lead to stomach ulcers.

While generalized stress, anxiety, and spicy foods do not cause ulcers, they can exacerbate existing ones.

Uncommon causes include hypersecretory disorders in which excessive stomach acids are produced. Examples include cystic fibrosis, basophilic leukemia, Zollinger-Ellison syndrome, and multiple endocrine neoplasias.

Similarly, any condition that causes increased intracranial pressure (pressure in the skull) can trigger the excessive production of stomach acids, causing what is known as a Cushing ulcer. In rare cases, a peptic ulcer may also be a sign of a blood cancer known as lymphoma.

Diagnosis

Diagnosing a stomach ulcer in children can be challenging given that some of the tests used for adults, such as the H. pylori antibody blood test, are less accurate in children.

Generally speaking, unless the symptoms are severe, doctors will start the investigation with minimally invasive tests. Among these:

  • GastroPanel blood tests are able to detect H. pylori and high levels of acid and pepsin (a gastric enzyme) consistent with gastritis.
  • Fecal antigen tests look for genetic evidence of H. pylori in a stool sample.
  • Urea breath tests measure the amount of carbon dioxide in exhaled air consistent with an active H. pylori infection.

A negative result from these tests would allow the doctor to rule out digestive disorders as the cause and avoid more invasive procedures.

If the tests are positive and the symptoms severe, a procedure known as an upper endoscopy would be ordered. Considered the preferred means of diagnosis, an endoscopy involves the insertion of a flexible fiberoptic scope into the throat to view the lining of the stomach. It is performed under mild sedation and can be used to pinch off tissue samples (called a pinch biopsy) for evaluation in the lab. Side effects include a sore throat, indigestion, heartburn, and nausea. Infection, perforation, or bleeding is possible but uncommon. 

barium X-ray, also known as a barium swallow or upper-GI series, is far less invasive but also less accurate, particularly if the peptic ulcer is small. It involves the swallowing of a chalky liquid containing barium, which coats the stomach and helps better identify abnormalities on X-ray. Side effects include upset stomach, nausea, vomiting, and constipation.

Treatment

If the ulcer is related to H. pylori, the doctor will prescribe a combination of drugs to eradicate the infection and normalize gastric acid levels so that the stomach can heal.

Eradicating H. pylori has proven difficult in recent years as increasing rates of antibiotic resistance have rendered many traditional therapies useless. To this end, doctors today will take a more aggressive approach by combining two or more antibiotics with an acid-reducing drug known as a proton pump inhibitor (PPI) and bismuth subsalicylate tablets (such as chewable Pepto-Bismol), which are able to coat and protect the stomach.

If a first-line therapy fails to provide relief, additional combinations will be tried until all signs of the infection have been erased. The duration of treatment is 14 days and typically involves the antibiotics clarithromycin and amoxicillin. Subsequent therapies may include tetracycline or metronidazole.

These antibiotics need to be taken as directed—and to completion—to avoid the development of antibiotic resistance. NSAIDs would be avoided to reduce gastric stress; Tylenol (ibuprofen) can instead be used to treat pain and fever.

Diet

During treatment, focus on providing your child foods that are easily digested and place little stress on the stomach. These include high-fiber fruits and vegetables, lean chicken and fish, and probiotics like yogurt. Avoid fried foods, spicy foods, acidic foods, carbonated drinks, or anything with caffeine (including tea and chocolate).

Surgery and Other Procedures

Ulcers can often be treated at the time of the endoscopic exam. When an ulcer is spotted, various instruments can be fed through the endoscope to seal off a ruptured blood vessel. This may involve a laser or electrocautery device to burn the tissue or an injection of epinephrine (adrenaline) to rapidly dilate the blood vessel.

Surgery is rarely used today to treat ulcers. It is only indicated if there is a perforation, an obstruction, severe bleeding, or the high risk of a perforation. If needed, elective surgeries can often be performed laparoscopically (with keyhole incisions), while emergency surgeries are usually performed as an open procedure.

A Word From Verywell

Finding out that your child has a peptic ulcer can be extremely upsetting. While your first instinct may be to attribute it to stress at home or school, more often than not there are underlying physical causes that can be readily treated.

With that being said, it is important to reduce your child's stress while undergoing investigations and treatment. The best way to do so is to help your child understand what a stomach ulcer is and what to expect moving forward.

If your child needs to lose weight, now is not the time to start. Focus first on healing the ulcer and resolving the underlying cause. Once your child is better, you should approach weight loss holistically with the appropriate diet and exercise plan.

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