Peptic Ulcers in Children

Symptoms, Diagnosis & Treatment

Child not feeling well enough to eat
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Many people, including some doctors, believe children don't develop peptic ulcers. Popular opinion used to be that peptic ulcers were caused by either living with intensive stress or frequently eating spicy foods. Now, however, many experts agree a type of bacteria known as Helicobacter pylori (H. pylori) is the primary cause of peptic ulcers in adults.

When studies and experience concluded that children also can suffer from ulcers, it was found that, unlike ulcers occurring in adults, H. pylori wasn't the culprit in most cases of 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 and appear to be the most common form of peptic ulcer to occur in children.

Certain medical conditions can contribute to the development of peptic ulcers in children. For example, children with severe burns may develop ulcers secondary to the stress of their injuries. The use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, and naproxen sodium, can make the stomach vulnerable to the harmful effects of acid and pepsin and may contribute to the development of ulcers.

Signs and Symptoms of Ulcers in Children

The following symptoms are also common with many other childhood illnesses; not always ulcers. If your child is experiencing any of these signs and symptoms, talk to your doctor for a definite diagnosis.

  • Burning pain in the abdomen between the breastbone and the belly button
  • Nausea
  • Vomiting
  • Feeding difficulties
  • Loss of appetite
  • Weight loss
  • Blood in vomit or bowel movements

How Ulcers Are Diagnosed

An upper endoscopy and barium x-ray are two of the most commonly used tests to diagnose ulcers. In an upper endoscopy, a doctor uses an endoscope to examine the insides of the esophagus, stomach, and duodenum - the first part of the small intestine.

The endoscope allows the doctor the see the walls and tissue of the upper digestive tract, and they will be able to make a diagnosis from there.

barium x-ray, also referred to as a barium swallow or upper-GI series, is much less invasive. You will have to drink a chalky colored liquid that contains the chemical barium. The barium coats the walls of the esophagus and stomach, and it is visible through x-ray. A doctor can locate ulcers, hiatal hernias, erosions and other abnormalities just by looking at the x-ray.

If an ulcer is found, the doctor will then test for H. pylori. While H. pylori usually isn't the cause of ulcers in children, it needs to be ruled out as a cause since the treatment for an ulcer caused by H. pylori is different from the treatment for an ulcer caused by NSAIDs.

How Ulcers in Children Are Treated

If the ulcer is H. pylori-related, the doctor will prescribe antibiotics. These antibiotics need to be taken as directed by your child's doctor. As with all antibiotics, you should finish the medication, even if the symptoms disappear early.

If the ulcer is medication-related, the child's doctor will advise you to not give your child NSAIDs, such as ibuprofen or aspirin, or any medications containing ibuprofen or aspirin. A doctor will most likely prescribe acid-reducing medications. These should be administered as prescribed by the doctor.

Most doctors won't recommend any major dietary restrictions unless certain foods are known cause problems for the child. There are some foods, though, that stimulate the production of acid in the stomach and can make an ulcer worse. These include any foods and beverages that contain caffeine, such as soft drinks and chocolate.

Ulcer Complications and Emergency Situations

Call your doctor immediately if your child is experiencing any of these symptoms:

  • Sudden and persistent pain in the belly
  • Blood in bowel movements (bowel movements that appear black or tarry)
  • Blood in vomit
  • Vomit that looks like coffee grounds

These symptoms can indicate the following serious problems:

  • Perforation. An ulcer becomes too deep and breaks through the stomach or duodenal wall.
  • Bleeding. Stomach acid or an ulcer breaks a blood vessel.
  • Obstruction. An ulcer blocks food that cannot pass through to the intestines.

Ulcers in children can be an upsetting experience for parents and child, but with timely and proper treatment, almost all ulcers can be cured.

Sources:

Mohammad Issa El Mouzan and Asaad Mohammad Abdullah, "Peptic Ulcer Disease in Children and Adolescents.[/link" Oxford University. 6 Aug 2008

"Stomach and Duodenal Ulcers (Peptic Ulcers)." 2004 50(6):328-330; doi:10.1093/tropej/50.6.328. Journal of Tropical Pediatrics - Children's Hospital Boston - Harvard Medical School. 6 Aug 2008

William D. Chey, M.D., F.A.C.G., A.G.A.F., F.A.C.P., Benjamin C.Y. Wong, M.D., Ph.D., F.A.C.G., F.A.C.P., "American College of Gastroenterology Guideline on the Management of Helicobacter pylori Infection." doi: 10.1111/j.1572-0241.2007.01393.x. American College of Gastroenterology. 6 Aug 2008.

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