Stomach and Duodenal Ulcers

Ulcers most commonly occur in the duodenum, except in the first two years of life, when they appear with similar frequency in both the stomach and the duodenum.

Ulcers are considered primary if they develop in otherwise healthy children and secondary if they are caused by a disease or treatment with certain drugs, including aspirin. Primary ulcers tend to occur in children with close relatives who have the same condition.

WHAT CAUSES STOMACH AND DUODENAL ULCERS?
Infection of the stomach or duodenum by a spiral bacterium known as Heliocobacter pylori is responsible for the development of almost all gastric and duodenal ulcers. Secondary ulcers are associated with head injuries, severe burns, widespread infection, shock, kidney failure, respiratory failure, abnormalities of the blood system and prematurity.

WHEN SHOULD I SUSPECT THAT MY CHILD HAS STOMACH OR DUODENAL ULCERS?
In the first two years of life, the most prominent symptoms are vomiting and slow growth. After six years of age, abdominal pain is the most common symptoms. Many children with ulcers have two to four episodes of pain a day, each episode lasting less than 30 minutes. Eating sometimes relieves the pain, but it may aggrevate it. The pain occurs at night in about one-third of children.

IS MEDICAL ATTENTION NECESSARY?
Yes. Although not all ulcers are dangerous, some can be serious, so treatment is often necessary.

HOW CAN THE PEDIATRICIAN TELL IF MY CHILD HAS STOMACH OR DUODENAL ULCERS?
Two tests—the urea breath test and a blood test that detects H. pylori—are used to diagnose ulcers. If the child has ulcer symptoms, both these tests may be performed. Another diagnostic test called endoscopy may also be performed. In this procedure, a viewing tube is passed through the esophagus into the stomach so that the lining can be examined directly.

WHAT TREATMENTS ARE AVAILABLE?
About half of all stomach and duodenal ulcers will heal without treatment, but they ususally recur. Also, long-term infection with H. pylori has been linked to stomach cancer. Therefore, it is important to eradicate the bacteria with a course of antibiotics and to heal the ulcer with medications that reduce stomach acid. Several different drug combinations have been tested and found effective at eliminating the bacteria in more than 98 percent of cases.

Surgery may be required for severe ulcers than cause intractable pain, uncontrolled bleeding or perforation of the stomach or duodenal wall. The simplest surgery involves removing the ulcer or sewing its borders together. In severe disease, more complicated operations may be required. Modern diagnostic and therapeutic techniques have greatly reduced the need for surgery, though.

PREVENTING STOMACH AND DUODENAL ULCERS
Although there is no sure way to prevent ulcers, the following guidelines may help:

• Never give aspirin and similar drugs such as ibuprofen to children unless a doctor explicitly prescribes them.

• Serve regularly scheduled meals.

• Serve the child small snacks between meals.

CARING FOR A CHILD WITH STOMACH OR DUODENAL ULCERS
No conclusive evidence supports the conventional wisdom that spicy foods and caffeine-containing drinks cause stomach and duodenal ulcers. The following steps, however, may be beneficial.

• Avoid foods that are known to cause discomfort to the child until the ulcers clear up.

• Reduce physical and emotional stress.

• Maintain adequate sleep and regular exercise.

• Administer the child's medications as prescribed by the doctor.

• Be aware of signs of early recurrence.

GETTING HELP
Call your doctor if your child develops ulcer symptoms, which may include:

• Abdominal pain, particularly at night

• Vomiting

• Nausea

• Heartburn

• Indigestion

• Black, tarry feces with a metallic smell (indicating blood in the stool)

• Excessive burping

• Anemia

• Slow growth

• Abdominal bloating and lethargy in the newborn

Excerpt from THE DISNEY ENCYCLOPEDIA OF BABY & CHILD CARE, © 1995 DSH Communications, Inc. This material is based on current medical research and, to the best of the editors' knowledge and understanding, is accurate and valid. However the reader should not use information contained in this material to alter a medically prescribed regimen or as a form of self-treatment, without seeking the advice of a licensed physician.