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Peptic Ulcer in Children

By William J. Cochran, MD, Associate, Department of Pediatrics GI and Nutrition;Clinical Professor, Department of Pediatrics, Geisinger Clinic, Danville, PA;Temple University School of Medicine

(For adults, see Peptic Ulcer Disease.)

A peptic ulcer is a round or oval sore in the lining of the stomach or duodenum where it has been eroded by stomach acid and digestive enzymes.

  • Sores form in the lining of the stomach or duodenum.

  • Symptoms in children include gnawing pain in the abdomen and vomiting.

  • The diagnosis is based on endoscopy and sometimes imaging tests.

  • Treatment includes drugs to reduce stomach acid and sometimes antibiotics.

Ulcers penetrate into the lining of the stomach or duodenum (the first part of the small intestine). Ulcers develop when the normal defense and repair mechanisms of the lining of the stomach or duodenum are weakened, making the lining more likely to be damaged by stomach acid.

Peptic ulcers are much less common among children than adults. As with adults, use of nonsteroidal anti-inflammatory drugs (NSAIDs) and infection with Helicobacter pylori bacteria can lead to the formation of peptic ulcers. In children, Helicobacter pylori is not as common a cause as in adults. Children whose parents have peptic ulcers are more likely to have ulcers especially if their parents are infected with Helicobacter pylori. Exposure to secondhand smoke is another risk factor for ulcers in children. Adolescents who drink alcohol or smoke are also more likely to develop ulcers. Children of any age can develop ulcers when they are extremely sick, such as after severe burns, injuries, and illnesses. These ulcers are referred to as stress ulcers.

Symptoms

The typical symptoms occur in the upper abdomen and include

  • Gnawing pain

  • Burning pain

  • Aching

  • Soreness

  • An empty feeling

  • Feeling of hunger

However, young children may not have the typical symptoms but may have abdominal pain and vomiting. Infants with ulcers may be fussy and irritable during and after feedings.

Complications of peptic ulcer

In children of any age, peptic ulcers can tear (perforate), bleed, or cause swelling leading to blockage of the stomach (obstruction).

Diagnosis

  • Endoscopy

  • For complications, imaging tests

Doctors diagnose peptic ulcer based on the results of an endoscopy. During this test, a flexible viewing tube (endoscope) is inserted through the child's mouth and down the esophagus into the stomach and first part of the duodenum. With an endoscope, a doctor can also do a biopsy (removal of a tissue sample for examination under a microscope) to determine whether an ulcer is caused by Helicobacter pylori bacteria. Stool tests can also be done to detect Helicobacter pylori.

If a complication, such as perforation, is suspected, doctors may do imaging tests such as x-rays, computed tomography (CT), or magnetic resonance imaging (MRI).

Treatment

  • Reduction of stomach acid

  • For Helicobacter pylori infection, antibiotics and drugs to reduce stomach acid

The main goal of peptic ulcer treatment is to reduce stomach acid. Drugs that reduce acid include proton pump inhibitors, histamine-2 (H2) blockers, and antacids (see Table: Drugs Used to Treat Peptic Ulcer Disease). It is also important to reduce things that increase acid production. For example, children should be kept away from caffeine and secondhand smoke.

Children who are infected with Helicobacter pylori are given antibiotics to eliminate the bacteria and a proton pump inhibitor to reduce stomach acid.

Surgery may be needed if a complication is present or if the ulcers return.