Duodenal and stomach ulcers in children are rare, and the signs and symptoms can be nonspecific. These are also called peptic ulcers that can occur in the mucosa, the inner lining of the stomach and intestines. Ulcer diets and OTC medications may not heal the ulcers since they can be caused by infection of H. pylori (Helicobacter pylori) bacteria. Children may require appropriate treatment, and eradicating causes can cure ulcers and avoid complications.
Read on to know the clinical features, causes, risk factors, diagnostic tests and procedures, complications, and treatments of peptic ulcers in children and ways to prevent them.
Signs And Symptoms Of Stomach And Duodenal Ulcers In Children
Sometimes ulcers can be asymptomatic. However, it is common to have a gnawing or burning pain in the stomach that lasts for a few minutes to hours.
The following symptoms may also be seen in the stomach and duodenal ulcers (1).
- Vomiting often with “coffee grounds” appearance or blood
- Lack of appetite
- Weight loss
- Anemia (pale skin)
When To Call Doctor
Seek medical care if your child has signs and symptoms of peptic ulcer. An ulcer may cause burning pain in the stomach in the morning and between meals.
If you notice dark stool and “coffee grounds” vomiting, then make an appointment with the pediatrician immediately. Sudden onset of sharp abdominal pain in a child with a peptic ulcer can be due to perforation that requires emergency care.
What Causes Peptic Ulcers In Children?
The leading cause of gastric (stomach) ulcers and duodenal ulcers is Helicobacter pylori infection although this is less often in children than in adults. Stress, diet, stomach acid and medication can all be causes of ulceration.
- pylori infection: These bacteria infect the inner lining of the stomach and duodenum. The inner mucous lining protects the stomach and intestine wall from stomach acid and digestive enzymes, such as pepsin. H.pylori may cause inflammation of these mucous membranes, thus resulting in ulcer formation.
- Stress: Physical stress such as injuries, severe burns, major surgeries, etc., may cause stomach ulcers. These stress-induced gastric ulcers are called Curling’s ulcers. However, emotional stress is not the cause of stress ulcer Psychological factors may only increase the perception of ulcer pain.
- Zollinger-Ellison syndrome or gastrinoma: This disease causes increased gastric acid secretion, thus causing ulcers. However, this disease is rare in the pediatric population.
- Nonsteroidal anti-inflammatory medicines (NSAIDs): Medications, such as ibuprofen, aspirin, and naproxen, may cause gastric ulcers. These medicines could be a major cause of non-HP ulceration.
Consumption of spicy food does not seem to increase the risk of peptic ulcers (1). Caffeine from coffee may increase the production of stomach acid. However, it is likely to aggravate pain in the existing ulcers (4). A pediatric gastroenterologist can diagnose the cause for the ulcers.
Who Are At Risk Of Peptic Ulcers?
Children who have increased risk of contracting Helicobacterial pylori infection are at increased risk of developing stomach and duodenal ulcers. These bacteria can reach your child through direct contact with saliva, vomit, or fecal matter of an infected person or through contaminated food and water.
The following factors could increase the risk of H.pylori infection in children (5).
- Living in overcrowded conditions
- Lack of clean water supply
- Unsanitary living conditions
- Living with an infected person
- Sharing utensils and other items with an infected person
- Not observing hand hygiene
You may seek medical care if you notice persistent symptoms such as heartburn, abdominal pain, dark stool, etc., in your child. Early diagnosis and treatment of H.pylori infection could prevent its complications.
How Are Peptic Ulcers Diagnosed In Children?
Pediatricians will listen to the history of symptoms and signs and conduct a physical examination. The following tests are ordered based on the assessment (6).
- Esophagogastroduodenoscopy (EGD) and biopsy is also called gastroscopy, duodenoscopy, or endoscopy. A small, flexible tube (endoscope) with special cameras and light is used to monitor the inner lining of the digestive tract. Ulcers are visualized, and tissue samples are taken with special tools if required. Stomach tissue samples are tested for the presence of pylori. This is the best way of getting a definitive diagnosis.
- Upper gastrointestinal (GI) series or an abdominal x-ray or barium enema. Upper GI series helps visualize the upper part of the digestive system. The child will have to drink a barium liquid (contrast) before taking an abdominal x-ray for visibility. This test is performed by a radiologist.
- Rapid urease test (CLO test) is a diagnostic test for pylori infection performed using biopsy samples.
- Stool test could help identify the presence of pylori infection. Stool occult blood test may help to determine blood in the stool.
- In a breath test, the doctor may give food or drink with radioactive carbon and ask to blow into a bag after some time. pylori breaks down carbon and forms carbon dioxide, and this can be found in the breath sample if your child has an infection.
- Blood test may help identify anemia and the presence of inflammatory and infectious markers in the blood.
Treatment For Peptic Ulcer In Children
Ulcer treatment may vary depending on the cause. The following medicines are generally considered for the treatment of peptic ulcer in children(7).
- Antibiotics destroy the bacteria in the stomach.
- H2- blockers, such as cimetidine and famotidine (Pepcid), help reduce the acid secretion in the stomach.
- Proton-pump inhibitors (PPIs), such as omeprazole and lansoprazole, reduce stomach acid production.
- Antacids help neutralize stomach acid. It may help relieve symptoms but do not cure the ulcer.
- Cytoprotective agents protect the mucosal layer of the digestive tract from digestive enzymes and stomach acid. Carafate (sucralfate) and Cytotec (misoprostol) are cytoprotective agents. These are also used for ulcer prophylaxis (prevention of ulcers).
- NSAID-induced ulcers are treated with the withdrawal of NSAIDs and the introduction of PPIs.
Treatment protocols for peptic ulcers and gastritis with H. pylori infection are known as Helicobacter pylori eradication protocols. These treatments aim at eradicating the bacteria along with relief from symptoms.
Any of the below-listed combination regimens with antibiotics and proton pump inhibitor with or without bismuth subsalicylate is given for optimal eradication (8).
- Triple therapy: First-line treatment using antibiotics clarithromycin and amoxicillin or metronidazole with oral PPI is given two times a day for 14 days.
- Quadruple therapy: This is second-line treatment with PPI, bismuth subsalicylate, tetracycline, and tinidazole or metronidazole for ten days.
- Sequential therapy: It is a dual therapy involving treatment with PPI and amoxicillin for the first five days. It is followed by standard triple therapy for another five days.
Pediatricians may change the antibiotics if your child has an allergy to a specific antibiotic and if there is any antibiotic resistance in your region.
Elective ulcer surgeries are rarely needed for the treatment of peptic ulcer disease since most children get better with medicines (4). However, perforated peptic ulcer requires laparoscopic omental patch repair (laparoscopic omentopexy) in pediatric patients.
Although several medications here are available over-the-counter, you may visit a pediatrician for diagnosis and exact dosage of medicines according to your child’s health status.
Complications Of Peptic Ulcers
Peptic ulcers may cause severe complications if left untreated or not treated well. The most common ulcer complications are (4):
- Bleeding: If the ulcers or sores are deep and erode into blood vessels, then it could cause severe internal bleeding. It can lead to bleeding ulcers. “Coffee grounds” vomit and black tarry stool are signs of peptic ulcer bleeding. This can lead to anemia and the requirement of blood transfusion if untreated for a long time.
- Perforation: An ulcer may cause a hole in the wall of the stomach or duodenum. Stomach acid, digestive enzymes, and food could spill into the abdominal cavity through this hole and result in peritonitis (inflammation of the abdominal wall). This is an emergency and will need urgent care.
- Obstruction: Ulcers at the end section of the stomach could block or narrow the intestinal opening. This prevents the entry of food to the intestines and results in severe vomiting.
- Gastric cancer: pylori infection and untreated stomach ulcers may trigger stomach cancer later in life.
Tips To Prevent Peptic Ulcer In Children
- Wash hands with soap and water
- Avoid sharing utensils and other items with an infected person
- Drink clean water
- Avoid eating or drinking in unhygienic places
- Consume fruits and vegetables after washing them properly
- Avoid giving NSAIDs for a long time without prescription
- Always take the medications such as Pantop (pantoprazole) given for ulcer prophylaxis were indicated
Avoiding spicy food, oily foods, or acidic food or having ulcer diets, such as bland diet, are not known to offer a cure for gastric or duodenal ulcers (9).
Frequently Asked Questions
1. How can I help my child live with peptic ulcers?
Follow the pediatrician’s prescription for the treatment. Although the symptoms disappear, the recommended course of therapy regimen should be followed to avoid the recurrence of H.pylori infection. You may ask your child to avoid intake of any food that may worsen the symptoms.
2. How long does it take for a stomach ulcer to heal?
Gastric ulcers (gastric) may take more time to heal than duodenal ulcers due to stomach acid. Complete cure of uncomplicated stomach ulcers and duodenal ulcers may take up to six weeks in most patients. However, the symptoms may subside much earlier, and often ulcer heals within two weeks (10). Ulcers caused by NSAIDs begin to heal almost immediately after cessation of drug dosage. Proton-pump inhibitors could further accelerate the healing process (11).
Stomach ulcers in children may occur due to an H. pylori infection, unhealthy diet, and several other reasons. Children may experience nausea, vomiting, anemia, and weight loss. If your child experiences sharp abdominal pain and dark stool, consult a doctor, who may diagnose the child using an endoscopy, biopsy, and stool test. Further, they may prescribe antibiotics, H2-blockers, PPIs, or antacids, depending on the diagnosis. Since H. pylori infection in the stomach may be recurrent, it is important to follow the complete treatment regimen. Also, the infection may be prevented by maintaining good hygiene, drinking clean water, and washing fruits and vegetables well before eating them.
2. Symptoms & Causes of Peptic Ulcers (Stomach Ulcers); The National Institute of Diabetes and Digestive and Kidney Diseases
3. Stomach and Duodenal Ulcers in Children; The University of Rochester Medical Center
4. Stomach and Duodenal Ulcers (Peptic Ulcers) in Children; The Children’s Hospital of Philadelphia
5. Rahul S Mhaskar, et al., Assessment of Risk Factors of Helicobacter Pylori Infection and Peptic Ulcer Disease; The United States National Library of Medicine
6. Diagnosis of Peptic Ulcers (Stomach Ulcers); The National Institute of Diabetes and Digestive and Kidney Diseases
7. Peptic ulcer healing drugs; Department of Health; The Government of the Hong Kong Special Administrative Region
8. Treatment for Peptic Ulcers (Stomach Ulcers); The National Institute of Diabetes and Digestive and Kidney Diseases
9. Eating, Diet, & Nutrition for Peptic Ulcers (Stomach Ulcers); The National Institute of Diabetes and Digestive and Kidney Diseases
10. Ulrich Scheurer, et al.; Gastric And Duodenal Ulcer Healing Under Placebo Treatment; The American Gastroenterological Association
11. Peptic Ulcer; Harvard Health; Harvard Medical School