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Ulcers in Children

“You’re giving me an ulcer!” This is something almost everyone has heard at some point. However, most people would be surprised to learn what actually causes an ulcer and (thankfully) how uncommon they are seen in kids.

What is an ulcer?

An ulcer is a break in the lining of the stomach or the small intestine. The insides of your intestines are very similar to the inside of your cheek: they are smooth and pink with a small network of blood vessels supplying blood and nutrients to the area.

In certain conditions however, the smooth lining of the intestines can break down and become eroded and jagged. This breakdown in the normal lining of the stomach or small intestine is an ulcer. Ulcers may lead to severe upper belly pain, back pain, nighttime waking with pain, weight loss, vomiting and bleeding into the intestines. It is important to note however that the presence of these symptoms does not definitively indicate the child actually 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 bacteria 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?

While symptoms lead a doctor to consider the diagnosis of an ulcer, ulcers are most often diagnosed with an upper endoscopy where the doctor looks at the lining of the child’s intestines with a special camera. Ulcers can also sometimes be seen on contrast x-rays as well.

How are ulcers treated?

If a cause of an ulcer is identified, treatment is tailored to each patient’s situation. Generally, an acid suppressing medicine is used along with a medicine that coats the lining of the stomach in order to help it heal. If a large ulcer is found at diagnosis, it is generally recommended to look again after treatment to ensure it has resolved. If someone develops recurrent ulcers, more complex testing is indicated such as blood testing or imaging.

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. For more information on Nationwide Children’s Gastroenterology clinics click here.

Steven Ciciora, MD, is the director of division educational activities in the Division of Gastroenterology, Hepatology and Nutrition at Nationwide Children's Hospital and an assistant professor of Pediatrics at The Ohio State University College of Medicine. Dr. Ciciora’s clinical interests involve all aspects of pediatric gastroenterology, including celiac disease, motility disorders, functional disorders and liver disease. His published research has focused on motility disorders. He has presented his work at national meetings and earned distinguished presentation honors at the American Neurogastroenterology and Motility Society’s Young Investigator Forum. His work in the community led to him being awarded the Down Syndrome Association of Central Ohio’s Commitment to Excellence Award. He is also an author for the American Academy of Pediatrics inaugural pediatric GI review program.

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