|SSM Cardinal Glennon Children's Medical Center|
Many people think that spicy foods cause peptic ulcers, but the truth is that bacteria called Helicobacter pylori (or H. pylori) are the main culprit. And while many believe that adults in high-stress jobs are the only ones affected, people of any age — even kids — can develop 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 happen when H. pylori or a drug weakens the protective mucous coating of the stomach and duodenum, letting acid get through to the sensitive lining beneath. Both the acid and the bacteria can irritate the lining and cause an ulcer.
H. pylori infection is usually contracted in childhood (perhaps through food, water, or close contact with an infected individual), but most people won't have any symptoms until they're older. Although H. pylori infection usually doesn't cause problems in childhood, it can cause gastritis (irritation and inflammation of the stomach lining), 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, while most experts agree that H. pylori infection is a top cause of peptic ulcers in adults, not all think 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 (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 these signs and symptoms, call your doctor:
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.
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:
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 last or get worse, doctors might do a follow-up endoscopy 6 to 12 months later to check for H. pylori.
Ulcers related to NSAID use 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 medicine has been taken.
If your child has a medication-related ulcer, the doctor will tell you to avoid NSAIDs, including any medicines that contain ibuprofen or aspirin. Also, be sure to give your child the prescribed acid-reducing medicine.
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 doctor immediately if your child has any of these symptoms:
For a child with peptic ulcer disease, the symptoms above could indicate a serious problem, such as:
If your child is taking NSAIDs and shows symptoms of peptic ulcer disease, get prompt medical help. 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: J. Fernando del Rosario, MD