An ulcer is a sore, which means it's an open, painful wound. Peptic ulcers refer to ulcers in the stomach or the upper part of the small intestine, called the duodenum. An ulcer in the stomach is called a gastric ulcer and an ulcer in the duodenum is called a duodenal ulcer. Helicobacter pylori (H. pylori) is a bacterium that causes peptic ulcers. Gastritis is irritation or inflammation of the lining of the stomach. An untreated H. pylori infection can result in gastritis.

Causes

Both a gastric ulcer and a duodenal ulcer result when H. pylori bacteria or a drug weaken the protective mucous coating of the stomach and duodenum, allowing acid to get through to the sensitive lining beneath. H. pylori bacteria survive in the stomach acid because they secrete enzymes that neutralize the acid. This mechanism allows H. pylori bacteria to make their way to the "safe" area – the protective mucous lining. Once there, the spiral shape of the bacteria help them burrow through the lining. Both the acid and the bacteria can irritate the lining and cause an ulcer to form.

The exact transmission of H. pylori is unknown but it is suspected that transmission occurs via bodily fluids. If left untreated, an H. pylori infection can cause gastritis. Gastritis can occur suddenly (acute gastritis) or gradually (chronic gastritis). Gastritis also can be caused by long-term use of aspirin and anti-inflammatory drugs.

An untreated H. pylori infection also can cause peptic ulcer disease or stomach cancer later in life. In the past, having peptic ulcers meant living with a chronic condition for several years or even a lifetime. But today, a better understanding of the cause of peptic ulcers and how to treat them means that most people can be cured.

Symptoms

Abdominal discomfort is the most common symptom of peptic ulcers. This discomfort usually feels like a dull, gnawing ache. The pain usually occurs two or three hours after a meal or in the middle of the night when the stomach is empty. The pain may come and go for several days or weeks. Discomfort is relieved by eating and taking antacid medications.

Other symptoms include:

• weight loss
• poor appetite
• bloating
• burping
• nausea
• vomiting
• dark stools (gastritis)

Some people experience only very mild symptoms or none at all.

Exams and Tests

In addition to taking a complete history from you and your child, and doing a thorough physical examination of your child, your child's pediatric GI specialist may perform tests to confirm if your child's symptoms are a result of ulcers.

Upper Gastrointestinal Barium X-ray (Upper GI)

This test will show the size and shape (known as the anatomy) of the upper GI tract through X-ray images. Before the test, the child will not be able to have anything to eat or drink for up to eight hours before the test is scheduled, depending on the age of the child. When the child arrives for the test in the X-ray area (known as Radiology) of the hospital, he/she will be given white liquid, called barium, to drink. This liquid will coat the GI tract and outline the esophagus, stomach and small intestines, and will show any ulcers. If the child is not able to, or refuses to, drink the barium, a tube may be placed through the nose into the esophagus, and the barium will be given through the tube.

Upper GI Endoscopy (EGD)

This test allows the pediatric gastroenterologist to examine the lining of the esophagus, stomach and duodenum (first part of small bowel) using a camera in a flexible tube called an endoscope. The procedure is done in the operating room under general anesthesia so that the child will not feel any pain. Your child's doctor will pass the endoscope through his/her mouth and examine the esophagus, stomach and the duodenum. After examining the upper GI tract and taking pictures, the doctor will collect biopsies (very small pieces of the tissue lining), which will be sent to a pathologist (a doctor who studies tissue, blood and other samples) to examine under a microscope for inflammation and other signs of disease. If an ulcer is bleeding, the doctor will use the endoscope to inject drugs that promote clotting or to guide a heat probe that cauterizes the ulcer.

Before the procedure your doctor will talk with you and your child and answer your questions. Some children may get a medication to help them relax before being taken to the operating room area. After the procedure your child will be taken to the recovery room, allowed to fully awaken, and then be brought out to you. The physician will discuss the preliminary findings of the procedure and show pictures taken during the procedure. Your child will be allowed to go home once he/she is fully awake and able to drink liquids. The total time spent at the hospital will depend on the testing and the time for the child to wake up. It is best to expect to spend four or five hours at the hospital.

If an ulcer is found, the pediatric GI specialist will test your child for H. pylori. This test is important because treatment for an ulcer caused by H. pylori is different than treatment for an ulcer caused by other things.

H. pylori is diagnosed through blood, breath, stool, and tissue tests. Most common is the blood test, which is done with a finger stick. For the breath test, the child drinks a solution. Their exhaled breath is collected and tested to confirm the presence or absence of H. pylori. If you are asked to conduct a stool test, you will be given a stool collection kit to take home. You will be given instructions for taking the sample to a laboratory for testing.

Treatment

H. pylori peptic ulcers are treated with drugs that kill bacteria, reduce stomach acid and protect the stomach lining. Antibiotics are used to kill the bacteria. Bismuth subsalicylate, a component of Pepto-Bismol, is used to protect the stomach lining from acid. It also kills H. pylori. Two types of acid-suppressing drugs might be used:

• H2 blockers -- work by blocking histamine, which stimulates acid secretion. They help reduce ulcer pain after a few weeks.
• Proton pump inhibitors -- suppress acid production by halting the mechanism that pumps the acid into the stomach.

Treatment usually involves a combination of antibiotics, acid suppressors, and stomach protectors. Antibiotic regimens recommended for patients may differ across regions of the world because different areas have begun to show resistance to particular antibiotics.

Gastritis treatment is based on the cause of the inflammation. Medications to decrease stomach acid release may be prescribed.

Points to Remember

• A peptic ulcer is a sore in the lining of the stomach or duodenum.
• The majority of peptic ulcers are caused by the H. pylori bacterium.
• H. pylori can be transmitted from person to person through close contact and exposure to fecal matter or vomit.
• Teach children to always wash their hands after using the bathroom and before eating.
• A combination of antibiotics and other drugs is the most effective treatment for H. pylori peptic ulcers.
• Gastritis (inflammation of the stomach) is most commonly caused by the H. pylori bacteria and use of aspirin or anti-inflammatory drugs.

For More Information

North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition - NASPGHAN.org

Children's Digestive Health & Nutrition Foundation - cdhnf.org