Stomach and Duodenal Ulcers

What are the symptoms of gastric and duodenal ulcers?

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

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

What causes gastric and duodenal 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 why your child may have an ulcer, H. pylori is most likely to be the cause.

Are there other contributing factors?

• Emotional stress is no longer thought to be a cause of ulcers; people who have ulcers often report that emotional stress increases ulcer pain.
• Physical stress may increase the risk of developing ulcers.
• Aspirin, ibuprofen, and naproxen sodium — also known as non-steroidal anti-inflammatory drugs — make the stomach vulnerable to the harmful effects of the digestive fluids hydrochloric acid and pepsin.

What are some complications from ulcers?

Without proper treatment, children with ulcers may experience serious complications. The most common problems include:

• Bleeding: As the lining of the stomach or duodenal wall is eroded, blood vessels may also be damaged, causing bleeding.
• Perforation: Sometimes a hole has worn through the wall of the stomach or duodenum, and bacteria and partially digested food can spill through the opening into the sterile abdominal cavity (peritoneum).
• Narrowing and obstruction: Ulcers located at the end of the stomach (where the duodenum is attached) can cause swelling and scarring, which can narrow or close the intestinal opening.

How do we diagnose stomach and duodenal ulcers?

Treatment differs depending on the cause of your child's ulcer, so it is crucial to correctly diagnose ulcer disease and H. pylori before starting treatment. Therefore, our specialists take care in conducting a complete medical history and physical examination of your child.

Diagnostic procedures for ulcers may include:

• upper GI (gastrointestinal) series: examination of the esophagus, stomach, and duodenum (the first section of the small intestine) with an endoscope (a small, flexible tube with a light and a camera lens at the end)
• 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.
• blood, stool, breath and stomach tissue tests: performed to detect the presence of H. pylori. Although some of the tests for H. pylori may occasionally give false-positive or false-negative results, these tests can detect the bacteria.

How do we treat stomach and duodenal ulcers?

Treatment may include:

• Lifestyle changes: 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.
• Stop smoking: Some children and teenagers smoke, with or without their parents' knowledge or permission. Smoking has been shown to delay how fast their ulcers heal and has been linked to the ulcer recurring.
• Medications: Physicians may treat stomach 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, but do not inhibit the release of acid
  • When treating H. pylori, these medications or procedures are often used in combination with antibiotics.
• Surgery. 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. Types include:

• 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.

In the future, laparoscopic methods may also be standard surgical treatments. A laparoscopy is a test that uses a tube with a light and a camera lens at the end (laparoscope) to examine organs and check for abnormalities. Laparoscopy is often used during surgery to look inside the body and avoid making large incisions. Tissue samples may also be taken for examination and testing.