Many people think that spicy foods cause peptic ulcers, but the truth is that bacteria
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
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
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:
burning pain in the abdomen between the breastbone and the belly button (the most
common ulcer symptom)
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.
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)
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)
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
Alcohol and smoking can aggravate
an ulcer. Also make sure that your child avoids coffee, tea, sodas, and foods that
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:
sudden, sharp, lasting belly pain
bloody or black bowel movements
bloody vomit or vomit that looks like coffee grounds
For a child with peptic ulcer disease, the symptoms above could indicate a
serious problem, such as:
perforation (when the ulcer becomes too deep and breaks through the stomach or
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, 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.