Peptic ulcers in children
I have an eight-year-old girl who was diagnosed with a peptic ulcer around two months ago. She has been on Zantac (4 ml.) since. She has not improved. The pain is worsening. She cries every night. I'm not sure where to go next.
Question:Robert Steele
Robert W. Steele, MD, is a board certified pediatrician at St. John's Regional Health Center in Springfield, MO. He graduated from medical... Read more
It has been noted for several years now that a major cause of peptic ulcer disease in adults is an infection with a bacteria called Helicobacter pylori. Since that time, researchers have tried to figure out how much of a role this bacteria plays in causing peptic ulcer disease in children. This has been a difficult task because children rarely get peptic ulcer disease, so finding children whom researchers can study has been troublesome. The infection becomes more prevalent in the teenage years, but before then, in the U.S., it remains rather uncommon. This is contrasted to those children in developing countries where up to 50% of ten year olds may have this infection. Another difficulty with studying this disease is that many more people have the infection than have peptic ulcer disease. In other words, the fact that a person is infected does not mean that person will have peptic ulcer disease. Nonetheless, it is clear that this infection plays a significant role in causing this disease.
No one is certain how this infection is acquired. A number of possibilities have been proposed including getting it from contaminated water or possibly from cats. However, most of the evidence points to picking it up from other infected individuals. How this occurs and how often it occurs is not known.
Diagnosis of having this infection may be done by several methods:
- There is a blood test that can show the person has been exposed to Helicobacter pylori.
- There is a breath test. This is done by having the child ingest a liquid which will breakdown into certain products if the bacteria is present. These breakdown products are then detected on a breath test.
- Endoscopy may be done. Endoscopy is a procedure in which the child is under general anesthesia, and a fiber optic camera is placed into the stomach to look for ulcers. If there is evidence of infection, a biopsy may be done to look for the bacteria.
There is a lot of controversy between doctors about the best method of finding out whether stomach pain in a child is caused by this infection or by something else. Some say a positive test of infection is reason enough to begin antibiotic treatment. The problem with that (as stated above) is a person may have the infection, but the infection may be in no way playing a part in the stomach pain. The stomach pain may be caused by something completely different, so starting antibiotic therapy would be needless in this situation. Therefore, current recommendations are to first confirm that peptic ulcer disease is indeed present by doing endoscopy. Without inflammation seen in the stomach or small intestine, it is difficult to say whether the pain is caused by peptic ulcer disease or not. Once the inflammation is seen, a test looking for the infection is usually done. And then, if it is positive, therapy with three medications is begun.
Lori, the first question should be how sure everyone is that peptic ulcer disease is the cause of the stomach pain. There are a number of reasons why eight year olds have stomach pain {see "Recurring abdominal pains"} only one of which is peptic ulcer disease. While the diagnosis of peptic ulcer disease may be done by special x-rays in adults, many pediatric gastroenterologists feel this is not a useful test in children due its false positive and false negative rate. Therefore, the diagnosis of peptic ulcer disease is usually made by doing endoscopy. If everyone is comfortable that peptic ulcer disease is indeed the cause of the pain, a test looking for Helicobacter pylori might be of significant help because this can be treated with medications.
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