The highly acidic digestive juices in the stomach and bowel can erode the delicate lining of the gastrointestinal tract, causing sores known as ulcers. The most common site is the duodenum: the portion of the small intestine that receives the soupy mixture of semidigested food from the stomach. Both duodenal ulcers and gastric (stomach) ulcers are referred to as “peptic” ulcers. The name alludes to pepsin, the digestive enzyme responsible for breaking down the protein in food.
Doctors used to believe that all ulcers were caused by diet and stress. We now know that a bacterium known as Helicobacter pylori is behind many adult ulcers. The percentage of adolescent ulcer patients infected with H. pylori may be in the neighborhood of 25 percent. Scientists believe that this common microorganism enters our bodies via food and water, and possibly through kissing. Half of all men and women over sixty carry the bacteria. Why the majority of them never develop peptic ulcer disease is a question still in search of an answer.
Symptoms that Suggest Peptic Ulcers may Include:
- Sharp, burning or gnawing pain in the upper abdomen that lasts anywhere from thirty minutes to three hours and comes and goes
- Appetite loss
- Weight loss
- Weight gain
- Nausea and vomiting
- Blood-tinged vomit
- Bloody stool
How Ulcers Are Diagnosed
Physical examination and thorough medical history, plus one or more of the following procedures:
- Endoscopic exam of the stomach (gastroscopy) or the upper bowel (esophagogastroduodenoscopy), including tissue biopsy, to detect H. pylori bacteria
To locate the source of gastrointestinal bleeding, the doctor may order one or more of the following:
- Stool blood test
- Complete blood count
- Prothrombin time blood test
- Sigmoidoscopy or colonoscopy
- Scintigraphic studies
- CAT (CT) scan
- Magnetic resonance imaging (MRI) scan
How Ulcers Are Treated
- Drug therapy: “When I started in gastroenterology in the 1970s,” says Dr. Alan Lake, a pediatrician and pediatric gastroenterologist at Baltimore’s Johns Hopkins University School of Medicine, “I was subjecting six to eight patients a year to partial removal of their stomachs to treat chronic peptic ulcer disease. But since the mid 1980s, I haven’t sent a single patient to surgery. The medication options that are now available have virtually eliminated the need for an operation.”
Several types of drugs are typically incorporated into treatment:
- Nonprescription antacids, taken intermittently to neutralize excess stomach acid and relieve abdominal pain.
- H2 blockers (cimetidine, rantidine, famotidine), which reduce acid production in the digestive tract.
- Antibiotics, if diagnostic tests reveal the presence of H. pylori.
- Acid pump inhibitors (omeprazole).
- Mucosal protective agents (sucralfate, misoprostol).
Youngsters taking H2 blockers should begin to feel significantly better after several weeks. The medication can then be discontinued. Your child can also resume eating normally; the bland diet of old has not been found to help treat or prevent ulcers. Should the disease recur—as happens in half to four-fifths of all cases—most pediatricians would recommend staying on the drug for six months to two years.