Most people, including doctors, used to believe that ulcers (sores) in the stomach or duodenum (the first section of the small intestine) were caused by stress, alcohol, or spicy foods. Now we know that this isn’t the case. In fact, these ulcers, called peptic ulcers, are most often (although not always) caused by bacteria—specifically, an organism called Helicobacter pylori.
H pylori infections occur at a low rate in children in the United States, but may infect more than 75% of children in developing countries. Although infections increase in frequency as people get older, most children and adults with H pylori will never develop an infection. No one is certain how H pylori is contracted, but person-to-person contact could play a role, as could transmission through contaminated food and water. The incubation period is also unknown.
Signs and Symptoms
When H pylori causes an ulcer, the intensity of the symptoms can vary. In some cases, there will be no symptoms at all. Ulcers can cause a burning or gnawing pain in the stomach that may come and go, often happening a few hours after eating, as well as during the night, and then actually subsiding while eating food and drinking water.
Other symptoms may include:
- Nausea and vomiting
- Loss of appetite
- Weight loss
- Bloody vomit and dark stools from bleeding in the stomach or duodenum
What You Can Do
In the past, doctors treated peptic ulcers by recommending a bland diet as well as bed rest. But today, these lifestyle strategies appear to be inappropriate approaches to managing ulcers.
When to Call Your Pediatrician
Contact your pediatrician if your child
- Has burning stomach pain that is worse between meals and in the early morning hours and feels better when he eats
- Has persistent abdominal pain, vomiting, loss of appetite, or weight loss
- Has bloody stools or bloody vomit
How Is the Diagnosis Made?
Your pediatrician will take a medical history of your child and may perform some simple tests. Your pediatrician may sometimes refer your child to a specialist to conduct the more complicated and invasive tests needed to make the diagnosis of an H pylori infection. These tests include analyzing a small piece of tissue (a biopsy) obtained through a device called an endoscope, which is threaded down the throat to the stomach. The tissue is then examined under the microscope and tested for evidence of H pylori infection. Your pediatrician can also look at the esophagus, stomach, and duodenum with x-ray film (an upper GI series). There are noninvasive tests that can determine whether bacteria are present by analyzing a child’s blood, stool, or breath. The breath test can detect carbon dioxide released by a product made by H pylori.
Doctors only prescribe treatment for H pylori infections if they have progressed to an actual ulcer. Combinations of antibiotics such as amoxicillin, clarithromycin, and metronidazole can be taken by your child to kill the bacteria. Make sure he takes the full course of these antibiotics as directed by your pediatrician. They are usually prescribed in combination with drugs called proton pump inhibitors or histamine receptor blockers that interfere with the production of acid in the stomach.
What Is the Prognosis?
An H pylori infection increases the risk of developing stomach cancer later in life.
There is no known way to prevent H pylori infections. However, a vaccine that could someday prevent the infection is currently being researched.