Peptic Ulcer in Children
(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.
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.
The typical symptoms occur in the upper abdomen and include
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.
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.
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.