Stomach ulcers are fairly uncommon in children.  When they do occur, they are most often associated with taking medicines, having an underlying medical condition, undergoing recent surgery, or having an infection of Helicobacter pylori.  "Peptic ulcer disease" is a phrase used to describe a condition where ulcers form in the stomach or the first part of the small intestines (the duodenum).  A stomach or duodenal ulcer usually presents with nausea, vomiting, and abdominal pain.  Fever and diarrhea are usually not present unless there is another illness also.  Treatment for stomach ulcers includes medications such as stomach acid blockers.  If there is an infection with H. pylori, then antibiotics should be given also.

What causes stomach ulcers?

Stomach ulcers are the result of damaging inflammation to the lining of the stomach.  The stomach wall is normally protected from the stomach's acid by a thin layer of mucous and bicarbonate (the body's natural antacid!).  When this layer is disrupted, the surface becomes red, irritated, swollen and painful and an erosion can develop.

H. pylori is a bacteria that has the amazing ability to survive the hostile acid environment of the stomach.  The bacteria hide close to the surface of the stomach lining, partially protected by the mucous layer.  There it causes inflammation by irritating the stomach lining and disrupting theacid-blocking mucus layer.

Many medicines can irritate the surface of the stomach.  Perhaps the most famous culprit is aspirin.  Ibuprophen and other drugs in the non-steroidal anti-inflammatory drug (NSAIDs) class can cause stomach ulcers.  These medicines slow production of the alkaline mucous that protects the surface of the stomach wall and also slow the stomachs ability to heal.  Many antibiotics and corticosteroids can also lead to stomach ulcers.

 

What are the symptoms of a stomach ulcer?

• Abdominal pain
• Nausea
• Vomiting

Red Flags (seek medical care immediately)

• Paleness
• Weakness
• Severe or persistent symptoms
• Blood in the vomit material
• Black, tar-like stools

How are stomach ulcers diagnosed? 

The most direct way to diagnose a stomach ulcer is by upper gastrointestinal endoscopy.  This procedure is done under anesthesia or deep sedation.  A small flexible tube with a camera on the end is inserted through the mouth and into the stomach.  The endoscopist (usually a Pediatric Gastroenterologist) is able to see the inside surface of the stomach on a video screen.  Most ulcers can be easily seen.  Small biopsy samples are taken and reviewed under a microscope by a pathologist (body tissue expert) to see if any inflammation is present that was not seen during the procedure.  Special stains are used that allow the pathologist to determine if H. pylori bacteria are present.

There are non-invasive ways to test for H. pylori infection: a blood antibody test, a stool antigen test and a breath analysis test (to look for the breakdown of urea, which is converted to carbon dioxide by H. pylori).  These tests are not able to determine if an ulcer is present.

How are stomach ulcers treated?

All children should be treated with a medicine that blocks stomach acid.  Some examples are:

• Prevacid®, Protonix®, Zegerid®, Nexium®, or Prilosec® or similar proton pump inhibitor – these medicines reduce the production of stomach acid.  This does not directly inhibit GER but GER that is less irritating to the esophagus may indirectly cause a decrease in GER frequency or severity.  This medicine can be given as a liquid or the dissolvable tablets can be dissolved in a small amount of milk or water. 
• Zantac®, Pepcid® or similar acid blocker – like Prevacid® these medicines reduce acid production.  Unfortunately Zantac® does not taste good to many infants and children who take the liquid form.

Acid blocking medications can be given intraveneously (IV) for severe ulcers or if the patient is vomiting.

If H. pylori is present, then the child should also receive 2 antibiotics for 10-14 days.  Some commonly used antibiotics include: amoxicillin, clarithromycin, and metronidazole.

Is H. pylori contagious?

Yes.  In the United States, nearly 40% of adults carry this bacteria in their gastrointestinal tracts.  It is much less common in children, but it is unknown how many children carry the bacteria without symptoms.  H. pylori is spread from person-to-person, but it is not found in the environment or in animals.  It is commonly spread from infected family members or in places where people live in close proximity.

Barry J. Marshall and J. Robin Warren for their discovery of "the bacterium Helicobacter pylori and its role in gastritis and peptic ulcer disease" receive the Nobel Prize for Medicine in 2005.