Stomach and Duodenal Ulcers (Peptic Ulcers)

An ulcer is an open sore, or lesion, usually found on the skin or mucous membrane areas of the body:

  • An ulcer in the lining of the stomach or duodenum, where hydrochloric acid and pepsin are present, is referred to as a peptic ulcer.
  • When the ulcer is in the stomach, it is called a gastric ulcer.
  • When the ulcer is in the duodenum, it is called a duodenal ulcer.

Stomach and Duodenal UlcersWhat causes gastric and duodenal ulcers?

  • Helicobacter pylori. Research shows that most ulcers develop as a result of infection with a bacterium called Helicobacter pylori (H. pylori). The bacterium produces substances that weaken the stomach’s protective mucus and make it more susceptible to the damaging effects of acid and pepsin. H. pylori is considered to be the primary cause in most cases. Learn more about H. pylori.
  • Stress. Although emotional stress is no longer thought to be a cause of ulcers, people with ulcers often report that emotional stress increases ulcer pain. Physical stress, however, may increase the risk of developing ulcers, particularly in the stomach. For example, people with injuries (such as severe burns) and people undergoing major surgery often require rigorous treatment to prevent ulcers and ulcer complications.
  • Acid and pepsin. It is believed that the stomach’s inability to defend itself against the powerful digestive fluids, hydrochloric acid and pepsin, contributes to ulcer formation.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs). These drugs (such as aspirin, ibuprofen and naproxen sodium) make the stomach vulnerable to the harmful effects of acid and pepsin. They are present in many nonprescription medications used to treat fever, headaches and minor aches and pains.

In adolescents and young adults additional causes can include:

  • Caffeine. Caffeine seems to stimulate acid secretion in the stomach, which can aggravate the pain of an existing ulcer. However, the stimulation of stomach acid cannot be attributed solely to caffeine.
  • Smoking. Studies show smoking increases the chances of getting an ulcer, slows the healing process of existing ulcers and contributes to ulcer recurrence. This is yet another health-related reason for children and teenagers who smoke to quit.

What are the symptoms of gastric and duodenal ulcers?

Although ulcers do not always cause symptoms, the most common ulcer symptom is a burning pain in the chest and upper abdomen. The pain often occurs between meals and in the morning. It may last from a few minutes to a few hours. Less common ulcer symptoms include:

  • Anemia
  • Bloating
  • Belching
  • Nausea and vomiting
  • Blood-tinged vomit
  • Poor appetite
  • Loss of weight
  • Feeling tired and weak.

The symptoms of stomach and duodenal ulcers may resemble other digestive conditions or medical problems. It is important to speak with a pediatric gastroenterologist if you suspect your child has an ulcer.

What are some complications from ulcers?

Without proper treatment, people 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 become damaged, resulting in 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) and cause peritonitis, an inflammation of the abdominal cavity and wall.
  • 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. This obstruction can prevent food from leaving the stomach and entering the small intestine, resulting in vomiting the contents of the stomach.

How are ulcers diagnosed?

Because treatment protocols may be different for different types of ulcers, it is important to properly diagnose the cause of a child’s ulcer before determining the right plan for treatment. In addition to a complete medical history and physical examination, diagnostic procedures for ulcers may include:

  • Upper GI (gastrointestinal) series. An examination of the esophagus, stomach, and duodenum (the first section of the small intestine). Your child will drink a fluid called barium. Barium is a chalky liquid used to coat the inside of organs so that they will show up on an X-ray. X-rays are then taken to look at your child’s upper digestive tract.
  • Endoscopy. A test that uses a small, flexible tube with a light and a camera lens at the end (endoscope) to examine the inside of part of the digestive tract. Tissue samples from inside the digestive tract may also be taken for examination and testing. Learn more about endoscopy.
  • 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, research shows that these tests can still be accurate in detecting the bacteria.

What is the treatment for stomach and duodenal ulcers?

Each child’s ulcer treatment is determined on a case-by-case basis. CHOC Children’s pediatric gastroenterologists work with each patient, his or her family, as well as referring physicians and other medical specialists as necessary in order to create a treatment plan that is mindful of your child’s medical, physical, social and emotional needs both now and in the future. Specific treatment is determined based on the following:

  • The child’s age, overall health and medical history
  • The extent of the ulcers and type of ulcers
  • The child’s tolerance for specific medications, procedures or therapies
  • The family’s opinion or preference.

In the past, doctors advised people with ulcers to avoid 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 ulcer patients. If it seems that certain foods cause irritation, please discuss the problem with your child’s doctor.

Recommended treatment may include:

  • Medications. Doctors may treat stomach and duodenal ulcers with several types of medications, including the following:
    — Antibiotics. Used to kill the bacteria.
    — H2-blockers. Reduce the amount of acid the stomach produces by blocking histamine, a powerful stimulant of acid secretion.
    — Proton pump inhibitors. More completely block stomach acid production by stopping the stomach’s acid pump—the final step of acid secretion.
    — Mucosal protective agents. Shield the stomach’s mucous lining from the damage of acid, but do not inhibit the release of acid.
  • Quit smoking and drinking alcohol. Some children and teenagers smoke or drink alcohol, with or without their parents’ knowledge or permission. Smoking and drinking have been shown to delay ulcer healing and has been linked to ulcer recurrence.
  • Surgery. In most cases, anti-ulcer medicines heal ulcers quickly and effectively, and eradication of H. pylori prevents most ulcers from recurring. Some patients do not respond to medication and may require surgery, although this is rare.

Helicobacter pylori – The Cause of Most Ulcers

Helicobacter pylori (H. pylori) is a bacterium that produces substances that weaken the stomach’s protective mucus and make it more susceptible to the damaging effects of acid and pepsin, thus creating ulcers. Learn more about H. pylori.