“You’re giving me an ulcer!” It is a phrase almost everyone has heard. However, most people would be surprised to learn what actually causes an ulcer and (thankfully) how uncommon they are in kids.
What Is an Ulcer?
An ulcer is a small sore or open break in the inner lining of your intestine. The inside of your child's stomach normally looks a lot like the smooth, pink lining on the inside of their cheek. When an ulcer forms, that smooth tissue breaks down, leaving a raw, irritated spot.
Common symptoms can include:
Strong pain in the upper belly or back
Pain that wakes your child up at night
Unexplained weight loss
Frequent vomiting
Signs of bleeding in the belly (such as dark or tarry stools)
Because these symptoms can also be caused by standard stomach bugs, stress, or temporary upset, having them does not automatically mean your child has an ulcer.
Who Gets Ulcers?
Ulcers are far less common in children than in adults. Children who get ulcers oftentimes are taking medicines (such as ibuprofen) which predispose to ulcer formation or are infected with a bacterium that has been shown to sometimes cause ulcers known as Helicobacter pylori. Rarely, ulcers are seen in children who are extremely sick and in the hospital for another reason altogether. There is no evidence that spicy foods or caffeinated beverages cause ulcers. However, taking such foods may aggravate an ulcer and give discomfort and pain which leads someone to consult with their doctor.
What About Stress?
For many years, it was thought that stress and anxiety led to the development of ulcers. However, we now recognize that emotional stress plays a minimal (if any) role in the development of ulcers. Rather, the bacteria Helicobacter pylori and the use of medicines like ibuprofen are responsible for the majority of rare ulcer cases seen in pediatric gastroenterology.
How Are Ulcers Diagnosed?
If your child's pediatric gastroenterologist suspects an ulcer based on their symptoms, they will order specific tests to be sure:
Upper Endoscopy: This is the most common and accurate test. While your child is asleep and comfortable under sedation, a doctor uses a tiny, flexible tube with a camera at the end to gently look directly at the lining of the stomach and intestine.
Imaging Tests: Occasionally, doctors may use specialized X-rays using a safe contrast liquid to look for sore spots.
How Are They Treated?
The good news is that pediatric ulcers are very treatable. Once the cause is identified, your child's care team will create a personalized plan that typically includes:
Acid-Reducing Medications: These help lower the amount of acid in the stomach so the lining can rest and heal naturally.
Protective Medications: Medicines that form a soothing coating over the stomach lining to protect it from further irritation.
Antibiotics: If H. pylori bacteria is found, a short course of medications will clear the infection. Doctors will need to perform confirmatory testing to make sure it has cleared.
If an ulcer was particularly large or stubborn, the doctor may recommend a follow-up check to make sure the stomach lining has completely healed. If a child develops ulcers more than once, doctors will run additional blood or imaging tests to look for any underlying reasons.
Remember, while ulcers are commonly cited in popular culture and drug advertising, they are exceedingly rare in childhood and can most often be treated effectively and easily in the unlikely case they are found.
Rajitha D. Venkatesh, MD, MPH, FAAP, is an attending pediatric gastroenterologist at Nationwide Children’s Hospital and Co-Director of the Eosinophilic GI Disorders Program. She is also an assistant professor of Clinical Pediatrics at The Ohio State University College of Medicine. Dr. Venkatesh attended Wilkes University for her undergraduate education as a Wilkes Scholar. She attended SUNY Upstate Medical University for medical school and was selected as a NIH Fogarty Clinical Scholar. She completed residency training in Pediatrics at Yale-New Haven Children Hospital, and fellowship training in Gastroenterology, Hepatology & Nutrition at Massachusetts General Hospital for Children (MGHfC).
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