Peptic Ulcers in Children

What are the symptoms of peptic ulcers?

Although ulcers don't always cause symptoms, the most common sign is a gnawing or burning pain in the abdomen between the breastbone and the navel. The pain often occurs between meals and in the early morning. It may last from a few minutes to a few hours. Less common peptic ulcer symptoms include:

• belching
• nausea
• vomiting
• poor appetite
• loss of weight
• feeling tired and weak

What causes peptic ulcers?

In the past, lifestyle factors, such as stress and diet, were believed to cause ulcers. More recently, research has shown that stomach acids contribute to ulcers. Research also shows that ulcers can develop as a result of an infection caused by the bacterium Helicobacter pylori (H. pylori). While all of these factors play a role in the reason your child may have an ulcer, H. pylori is most likely to be the cause.

Other contributing factors may include physical stress and non-steroidal anti-inflammatory drugs, such as aspirin, ibuprofen, and naproxen sodium that make the stomach vulnerable to the harmful effects of the digestive fluids hydrochloric acid and pepsin.

How are peptic ulcers diagnosed?

The treatment for peptic ulcers differs depending on the cause, so it is crucial to correctly diagnose ulcer disease before starting treatment. Your doctor will conduct a complete medical history and physical examination of your child. Diagnostic procedures for your child's ulcer may include:

• Blood, stool, or breath tests: These tests are performed to detect for signs of blood loss, inflammation, and the presence of H.pylori in the stool.
• Endoscopy: A test that uses an endoscope to examine the inside of part of the digestive tract. Tissue samples from inside the digestive tract may also be taken for examination.
• Upper GI gastrointestinal) series: An x-ray examination done with swallowed contrast material to outline the GI tract.

How are peptic ulcers treated?

Lifestyle changes

There are a number of different treatment options for gastric and duodenal ulcers. In the past, physicians advised parents to avoid feeding their children with ulcers spicy, fatty, or acidic foods. However, a bland diet is now known to be ineffective for treating or avoiding ulcers. No particular diet is helpful for most children with ulcers.

Some children and teenagers smoke, with or without their parent's knowledge or permission. Smoking has been shown to delay how fast ulcers heal, and has been linked to the ulcer recurring. Alcohol consumption is also irritating to the lining of the GI tract.

Medications

Physicians may treat gastric and duodenal ulcers with several types of medications, including the following:

• H2-blockers to reduce the amount of acid the stomach produces by blocking histamine, a powerful stimulant of acid secretion
• proton pump inhibitors to more completely block stomach acid production by stopping the stomach's acid pump — the final step of acid secretion
• mucosal protective agents to shield the stomach's mucous lining from the damage of acid

When treating H. pylori, these medications or procedures are often used in combination with antibiotics. In most cases, anti-ulcer medicines heal ulcers quickly and effectively, and eradication of H. pylori prevents most ulcers from recurring. However, children who don't respond to medication or who develop complications may require surgery. When surgery is needed it may require one or more of the following procedures:

• Vagotomy: A procedure that involves cutting parts of the vagus nerve (a nerve that transmits messages from the brain to the stomach) to interrupt messages sent through it, therefore, reducing acid secretion.
• Antrectomy: An operation to remove the lower part of the stomach (antrum), which produces a hormone that stimulates the stomach to secrete digestive juices. Sometimes a surgeon may also remove an adjacent part of the stomach that secretes pepsin and acid. A vagotomy is usually done in conjunction with an antrectomy.
• Pyloroplasty: A surgical procedure that may be performed along with a vagotomy, in which the opening into the duodenum and small intestine (pylorus) are enlarged, enabling contents to pass more freely from the stomach.

When treating H. pylori, these medications or procedures are often used in combination with antibiotics. In most cases, anti-ulcer medicines heal ulcers quickly and effectively, and eradication of H. pylori prevents most ulcers from recurring.

How we care for peptic ulcers

The Division of Gastroenterology, Hepatology and Nutrition at Boston Children's Hospital cares for infants, children, and young adults with gastrointestinal conditions like peptic ulcers. We provide the most comprehensive and leading-edge endoscopic services in the country for the care and treatment of peptic ulcers.