What are stomach and duodenal ulcers (peptic ulcers)?

About duodenal ulcers (stomach 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 peptic ulcer is located in the stomach, it is called a gastric ulcer. When the peptic ulcer is located in the duodenum, it is called a duodenal ulcer.

What causes gastric and duodenal ulcers?

In the past, it was believed lifestyle factors, such as stress and diet, caused ulcers. Later, researchers determined that stomach acids — hydrochloric acid and pepsin — contributed to ulcer formation.

Today, research shows that most ulcers (80 percent of gastric ulcers and 90 percent of duodenal ulcers) develop as a result of infection with a bacterium called Helicobacter pylori (H. pylori). This bacterium produces substances that create more acid, weaken the stomach’s protective mucus and make it more susceptible to the damaging effects of acid and pepsin.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are another common cause of ulcers in children. 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 non-prescription medications used to treat fever, headaches and minor aches and pains.

Although much less common, these other factors can contribute to the development of ulcers in children:

• 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.
• 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.
• 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.

What are the symptoms of gastric and duodenal ulcers?

The following are the most common symptoms for ulcers. However, each individual may experience symptoms differently.

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

• Belching
• Nausea
• Vomiting
• Poor appetite
• Loss of weight
• Feeling tired and weak

The symptoms of stomach and duodenal ulcers may resemble other digestive conditions or medical problems. Consult your child's physician for a diagnosis.

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 also be damaged, causing 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 adequately diagnose ulcer disease and H. pylori before starting treatment. For example, for an NSAID-induced ulcer, treatment is quite different from the treatment for a person diagnosed with an ulcer caused by the bacterium, H. pylori.

In addition to a complete medical history and physical examination, diagnostic procedures for ulcers may include:

• Upper GI (gastrointestinal) series - examination of the esophagus, stomach and duodenum (the first section of the small intestine) with an endoscope (a small, flexible tube with a light and a camera lens at the end).
• 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. 

• 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 results or may give false-negative results in people who have recently taken antibiotics, omeprazole, or bismuth, research shows these tests can be accurate in detecting the bacteria.

Treatment for stomach and duodenal ulcers:

Specific treatment will be determined by your child's physician based on the following:

• Your child's age, overall health and medical history.
• The extent of the disease.
• Your child's tolerance for specific medications, procedures or therapies.
• The expectations for the course of the disease.
• Your opinion or preference.

Recommended treatment may include:

• Lifestyle changes. In the past, physicians 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 physician.

Some children and teenagers smoke, with or without their parent's knowledge or permission. Smoking has been shown to delay ulcer healing and has been linked to ulcer recurrence.

• Medications. Physicians may treat stomach and duodenal ulcers with several types of medications, including the following:
  
  • H2-blockers - to reduce the amount of acid the stomach produces by blocking histamine, a powerful stimulant of acid secretion.
  • Proton pump inhibitors - to more completely block stomach acid production by stopping the stomach's acid pump - the final step of acid secretion.
  • Mucosal protective agents - to shield the stomach's mucous lining from the damage of acid, but do not inhibit the release of acid.

When treating H. pylori, these medications or procedures are often used in combination with antibiotics.

• Surgery - In most cases, anti-ulcer medicines heal ulcers quickly and effectively, and eradication of H. pylori prevents most ulcers from recurring. However, rarely people do not respond to medication and may require surgery