Stomach ulcers are frequently caused by a bacteria known as Helicobacter pylori (H. pylori), but they are sometimes associated with a more serious disease, such as cancer.
Diagnosing stomach ulcers in children is slightly different than it is in adults, as some tests are less able to deliver reliable results. Usually, uncomplicated cases are easily treated with antibiotics and drugs that reduce stomach acid and protect the stomach lining.
Unless there is a serious underlying cause, the risk of complications from a stomach ulcer is low (between 1% and 2%) and the mortality rate is approximately one death every 100,000 cases.
Stomach Ulcer Symptoms
A stomach ulcer is simply an open sore that develops on the lining of the stomach. A sore in the stomach itself is referred to as a gastric ulcer, while one that develops further along toward the small intestine is called a duodenal ulcer.
The common signs of a stomach ulcer include:
A dull burning or gnawing ache in the stomachGas and bloatingNausea or vomitingLoss of appetiteFatigue
The pain is often most noticeable when the stomach is empty, but pain that occurs after eating can often distinguish a gastric ulcer from a duodenal one. Gastric ulcers will usually cause pain soon after food is eaten, while the pain from a duodenal ulcer will usually develop two or three hours later.
A child’s stomach ulcer can be considered severe if the pain is sharp and specific rather than dull and aching. This may be an indication that the ulcer is bleeding, a condition often accompanied by bloody or tarry stools or vomiting of blood or coffee-like particles.
Complications of a stomach ulcer may include malnutrition, gastric perforation, and bowel obstruction caused by inflammation of the duodenum. Both an obstruction and perforation are considered medical emergencies requiring immediate attention.
What Causes Stomach Ulcers in Children?
H. pylori is a corkscrew-shaped bacterium commonly linked to chronic gastritis and stomach ulcers. Around 50% of the world’s population is believed to have H. pylori. According to one study, over 30% of these people will develop upper gastrointestinal symptoms.
While H. pylori is a common cause of stomach ulcers in children, other factors may either cause or contribute to their development. Among them are:
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen, which may lead to gastric bleeding and ulcers when overused Genetics, with a family history present in about 20% of children who have stomach ulcers Extremely stressful events (such as major life trauma, injury, infection, or surgery), which may trigger acute symptoms that occur within three to six days Obesity, which can lead to increased gastrointestinal inflammation and changes in the normal gut bacteria Gastroesophageal reflux disease (GERD), in which chronic acid reflux can lead to stomach ulcers in severe cases
Uncommon causes include hypersecretory disorders in which excessive stomach acids are produced. Examples include cystic fibrosis, basophilic leukemia, Zollinger-Ellison syndrome, and multiple endocrine neoplasias.
Similarly, any condition that causes increased intracranial pressure (pressure in the skull) can trigger the excessive production of stomach acids, causing what is known as a Cushing ulcer. In rare cases, a stomach ulcer may be a sign of blood cancer known as lymphoma.
Diagnosis of Stomach Ulcers
Diagnosing a stomach ulcer in children can be a challenge. Some of the tests used for adults, such as the H. pylori antibody blood test, are less accurate in children.
Unless the symptoms are severe, a healthcare provider usually will start the investigation with minimally invasive tests. Among these are:
GastroPanel blood tests, able to detect H. pylori and high levels of acid and pepsin (a gastric enzyme) that are consistent with gastritisFecal antigen tests, which look for genetic evidence of H. pylori in a stool sampleUrea breath tests, used to measure the amount of carbon dioxide in exhaled air, which can indicate an active H. pylori infection
A negative result from these tests would allow your healthcare provider to rule out digestive disorders as the cause before moving on to more invasive procedures.
Imaging Tests
If the tests are positive and the symptoms severe, a procedure known as an upper endoscopy would be the preferred next step to diagnose a stomach ulcer in the child. An endoscopy involves the insertion of a flexible fiberoptic scope down the throat to view the lining of the stomach.
It is performed under mild sedation and can be used to pinch off tissue samples (called a pinch biopsy) for evaluation in the lab. Side effects may include:
Sore throatIndigestionHeartburnNauseaInfectionPerforationBleeding
A barium X-ray, also called a barium swallow or upper-GI series, is far less invasive but also less accurate. This is especially true if the stomach ulcer in a child is small.
For this test, they would swallow a chalky liquid containing barium, which coats the stomach and helps to better identify abnormalities on X-ray. Side effects include upset stomach, nausea, vomiting, and constipation.
Stomach Ulcer Treatment
If your child’s stomach ulcer is related to H. pylori, the healthcare provider will treat the infection with a combination of drugs meant to normalize gastric acid levels so that their stomach can heal.
In many cases, your child’s stomach ulcer may be treated with two or more antibiotics together, along with an acid-reducing drug known as a proton pump inhibitor (PPI). They also may take bismuth subsalicylate tablets (such as chewable Pepto-Bismol) that are able to coat and protect the stomach.
If this treatment fails, other drug combinations will be used until all signs of the infection are gone. Treatment usually lasts 14 days and typically involves the antibiotics clarithromycin and amoxicillin. Subsequent therapies may include tetracycline or metronidazole.
These antibiotics need to be taken as directed—and to completion—to avoid the development of antibiotic resistance. NSAIDs should be avoided to reduce gastric stress, while Tylenol (acetaminophen) can instead be used to treat pain and fever in your child.
Diet
During treatment, you can focus on giving your child foods that are easy to digest and place little stress on the stomach. These include high-fiber fruits and vegetables, lean chicken and fish, and probiotics like yogurt. Avoid fried foods, spicy foods, acidic foods, carbonated drinks, or anything with caffeine (including tea and chocolate).
Surgery and Other Procedures
Often, stomach ulcers in children can be treated at the time of their endoscopy. When an ulcer is spotted, various instruments can be fed through the endoscope to seal off a ruptured blood vessel. This may involve a laser or an electrocautery device to burn the tissue, or an injection of epinephrine (adrenaline) to rapidly dilate the blood vessel.
Surgery is rarely used to treat stomach ulcers in children. It is only indicated if there is a perforation, an obstruction, severe bleeding, or a high risk of a perforation. If needed, elective surgeries can often be performed through laparoscopy (with keyhole incisions), while emergency surgeries are usually performed as an open procedure.
A Word From Verywell
Finding out that your child has a stomach ulcer can be upsetting. Your first instinct may be to attribute the cause to stress at home or school, but more often than not there are underlying and treatable physical causes.
While your child is receiving care, though, it’s important to reduce stress. It will help for you to explain to your child what a stomach ulcer is and what to expect moving forward. But if your child needs to lose weight, now is not the time to start. Focus first on healing the ulcer and any underlying cause before moving forward with a diet and exercise plan.
BurpingFullness after only eating small amounts of foodNauseaNot feeling hungerStool that is bloody or blackRegular vomiting or vomiting bloodUnintentional weight loss
Some of these symptoms can resemble many other health issues, but your healthcare provider can help determine their cause.
