By: Ifunanya Agbim, MD, FAAP & Christine Waasdorp Hurtado, MD, FAAP
A peptic ulcer is an open sore in the lining of the digestive tract, usually the stomach or upper intestine. Ulcers mostly affect adults, but children and teens can get them, too.
Here's what parents need to know about causes and symptoms of ulcers in kids, and how they're treated.
How do ulcers form?
Peptic ulcers can form when there is too much of an enzyme called pepsin. Pepsin plays a big role in digestion, breaking down protein in our food. But when the body produces too much pepsin, it can damage the mucosa (inner lining) of the digestive tract. That leads to an ulcer.
Types of ulcers
Ulcers are named for where they form. When an ulcer develops in the stomach, it's called a gastric ulcer. Ulcers can also form in the first part of the small intestine. These are called duodenal ulcers.
What causes ulcers?
In the past, diet and stress were thought to be the most common cause of ulcers. However, we now know there are numerous causes of peptic ulcers, including:
H. pylori
One of the leading causes of peptic ulcers is a type of bacteria called
Helicobacter pylori (H. Pylori). It can enter the body through food and water and then live in the digestive tract. Many people with
H. Pylori remain healthy and never develop symptoms of peptic ulcers. However, others who carry the bacteria develop significant pain and discomfort and require treatment.
NSAIDs
Certain types of medications for pain and swelling, such as ibuprofen and naproxen sodium (also known as nonsteroidal anti-inflammatory drugs for NSAIDs), are another common cause of peptic ulcer disease. That's because NSAIDs block certain enzymes that help shield the lining of the digestive tract. This makes the lining more prone to irritation and damage from stomach acid.
Other causes
Some viruses (Epstein-Barr virus), inflammatory bowel disease (particularly Crohn's disease) and cancer
treatments (radiation and chemotherapy) are also linked with peptic ulcers.
What are the signs and symptoms of peptic ulcers?
Sharp, burning or gnawing pain in the upper abdomen which comes and goes, but is often present after eating or at night
Loss of appetite
Weight loss
Nausea and vomiting
Dark colored stool
Bloating
Belching
Anemia
Vomit or stool with blood in it
How are ulcers diagnosed?
One or more of the following are often performed to diagnose peptic ulcer disease:
Physical exam and a thorough medical history
Blood tests to look for anemia by checking blood cell count and iron levels
Stool test to check for blood and/or for
H. pylori
Breath tests to check for urea, a substance produced when protein breaks down in the body.
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Esophagogastroduodenoscopy (EGD), an exam of the upper gastrointestinal (GI) tract using a hollow tube equipped with a type of camera called an endoscope. During the procedure, a small sample of tissue is taken for a biopsy to detect
H. pylori. EGD is the most accurate diagnostic test. It can also help to look for active bleeding and guide treatment.
How are peptic ulcers treated children and teens?
Several types of drugs may be used in treatment:
H2 blockers (cimetidine, famotidine), which reduce acid production in the digestive tract
Antibiotics, if diagnostic tests reveal the presence of
H. pylori. This may be given in combination with bismuth salicylate, a medication for diarrhea, heartburn, nausea and upset stomach.
Proton pump inhibitors (pantoprazole, omeprazole, esomeprazole, lansoprazole), which decrease the amount of stomach acid produced
Mucosal protective agents (sucralfate) to protect the lining of the digestive tract from gastric acid
Nonprescription antacids taken as needed to neutralize excess stomach acid and relieve abdominal pain
How long does it take a stomach ulcer to heal?
It could take about 6–8 weeks after treatment for ulcer symptoms to resolve. Your child can start eating a normal diet slowly during this time as they are feeling better.
Peptic ulcers occasionally come back after healing. When this happens, repeat treatment with medications for a prolonged period of time (6 months to several years) may be recommended.
More information
About Dr. Agbim
 Ifunanya Agbim, MD, FAAP, is a pediatric gastroenterologist at Children's Wisconsin–Milwaukee Campus and an Assistant Professor of Gastroenterology in the Department of Pediatrics at the Medical College of Wisconsin.
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About Dr. Waasdorp Hurtado
 Christine Wassdorp Hurtado, MD, MSCS, FAAP, is a member of the American Academy of Pediatrics and North American Society of Pediatric Gastroenterology Hepatology and Nutrition. She is a Professor of Pediatrics at the University of Colorado School of Medicine and practices in Colorado Springs.
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