Overview

An ulcer is an open sore (lesion). It’s normally found on the skin or mucous membranes.

A peptic ulcer is in the lining of the stomach or duodenum. A gastric ulcer is in the stomach. A duodenal ulcer is in the duodenum.

Causes

Experts used to believe that stress, diet, and stomach acid caused ulcers. Today, research shows that most ulcers form because of an infection with Helicobacter pylori (H. pylori) bacteria. Other factors play a role, but this germ is often the main cause of most ulcers.

The following factors may play a role in stomach or duodenal ulcers:

  • H. pylori. This germ makes substances that weaken the protective mucus in your child’s stomach. This makes it more likely to get damaged from acid and pepsin.
  • Smoking. Studies show smoking increases the chances of getting an ulcer. It also slows the healing process of ulcers and causes ulcers to come back.
  • Caffeine. Caffeine may cause the stomach to release acid. This may make the pain of an existing ulcer worse.
  • Stress. Emotional stress is no longer thought to cause ulcers. But people with ulcers often say that their stress increases ulcer pain. Physical stress may increase the risk for ulcers, especially in the stomach. For example, people with injuries, such as burns, and people who have major surgery often need treatment to prevent ulcers and ulcer complications.
  • Acid and pepsin. The stomach can’t always fully defend itself against strong digestive fluids. These include hydrochloric acid and pepsin. This may cause ulcers to form.
  • Nonsteroidal anti-inflammatory medicines (NSAIDs). These medicines make the stomach vulnerable to the harmful effects of acid and pepsin. These medicines include aspirin, ibuprofen, and naproxen. These ingredients are in many over-the-counter medicines. They are used to treat fever, headaches, and pain.

Risk Factors

The greatest risk factor for gastric and duodenal ulcers is an H. pylori infection. Things that make an H. pylori infection more likely include:

  • Living in overcrowded conditions
  • Sharing a bed
  • Genetics. Children with Hispanic and African-American backgrounds have a higher risk.

Symptoms

Ulcers don’t always cause symptoms.

The most common symptom is a gnawing or burning pain in the stomach. This is often felt between the breastbone and the belly button (navel). Your child may feel the pain more between meals and in the early morning. It may last from a few minutes to a few hours.

Less common ulcer symptoms include:

  • Anemia
  • Bloating
  • Belching
  • Nausea and vomiting
  • Vomit with blood in it
  • Poor appetite
  • Weight loss
  • Tiredness and weakness

The symptoms of ulcers may look like other health problems. Make sure your child sees his or her healthcare provider for a diagnosis.

Diagnosis

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.

Your child’s treatment will also depend on what’s causing his or her ulcer. For instance, ulcers caused by H. pylori need different treatment from ulcers caused by using NSAIDs.

Your child’s healthcare provider will ask about his or her health history. He or she will also give your child an exam. Your child may need more tests before his or her ulcer is diagnosed.

Upper GI (gastrointestinal) series

This test looks at the organs in the upper part of your child’s digestive system. For this test, your child will swallow barium. This is a metallic liquid that coats the inside of his or her organs. This helps them show up on an X-ray better. Then your child’s healthcare provider will take an X-ray of these organs.

Endoscopy

In this test, a small, flexible tube (endoscope) is used to look at the inside of your child’s digestive tract. This tube has a light and a camera lens at the end of it. During the test, the healthcare provider may take tissue samples from your child's digestive tract. The provider will test these samples.

Blood, stool, breath, and stomach tissue tests

These tests are done to look for H. pylori.

Treatment

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.

Lifestyle changes

In the past, healthcare providers told people with ulcers to avoid spicy, fatty, or acidic foods. But healthcare providers now know this type of diet doesn’t help ulcers. In fact, no diet has shown to help people with ulcers. If it seems that certain foods make your child’s ulcer worse, talk with his or her healthcare provider.

Some children and teenagers smoke cigarettes. Parents don’t always know that their children smoke. Smoking slows the healing process of ulcers and causes ulcers to come back.

Medicines

Your child may need to take medicine. If your child has H. pylori, he or she may need more than one medicine. Medicines used to treat ulcers include:

  • Antibiotics. These medicines kill bacteria.
  • H2-blockers. These medicines reduce the amount of acid the stomach makes. They do this by blocking histamine, which causes acid to be released.
  • Proton pump inhibitors. These medicines block stomach acid production. They work by stopping the stomach's acid pump. This is the last step of acid secretion.
  • Mucosal protective agents. These medicines protect the stomach's mucous lining from the damage of acid. They don’t stop acid from being released.

Surgery

Most of the time, medicine heals ulcers and they don’t come back. In rare cases, people don’t respond to medicine and need surgery.

Complications

Your child could have severe complications if his or her ulcer isn’t treated well. The most common problems include:

  • Bleeding. An ulcer can harm blood vessels. This can cause bleeding.  
  • Hole (perforation). An ulcer can wear a hole through the wall of the stomach or duodenum. Bacteria and partially digested food can spill through the opening into the abdominal cavity (peritoneum). This can cause peritonitis. This is inflammation of the abdominal cavity and wall.
  • Narrowing and blockage (obstruction). Ulcers at the end of the stomach where the duodenum is attached can cause swelling and scarring. This can narrow or close the intestinal opening. This blockage can stop food from leaving the stomach and going into the small intestine. This can cause vomiting.

Prevention

Preventing H. pylori can reduce your child’s risk of ulcers. It isn’t fully understood how this infection is spread. But the following may lower your child’s risk of H. pylori:

  • Washing hands often
  • Not having close contact with someone who has H. pylori
  • Not eating or drinking contaminated food or water

Living with

Most people with stomach ulcers are cured with treatment. Work with your child’s healthcare provider to make a care plan for your child.

When to Call a Healthcare Provider

Call your child’s healthcare provider if your child has signs of an ulcer. These include a gnawing or burning pain in his or her stomach that happens between meals or in the morning.

Key Points

  • Stomach and duodenal ulcers are open sores. They happen in the lining of the stomach or the duodenum.
  • Most ulcers are caused by an infection with Helicobacter pylori.
  • Treatment often includes antibiotics and medicines to block stomach acid production.
  • Without proper treatment, people with ulcers may have serious complications. But most people are cured with treatment.

Next Steps

Tips to help you get the most from a visit to your child’s healthcare provider:

  • Know the reason for the visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
  • Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
  • Ask if your child’s condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if your child does not take the medicine or have the test or procedure.
  • If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.