Stomach and Duodenal Ulcers | Diagnosis & Treatments

How we diagnose stomach and duodenal ulcers

Treatment differs depending on the cause of your child's ulcer, so it is crucial to correctly diagnose ulcer disease and H. pylori before starting treatment. Therefore, our specialists take care in conducting a complete medical history and physical examination of your child.

Diagnostic procedures for ulcers may include:

  • upper GI (gastrointestinal) series: examination of the esophagus, stomach, and duodenum (the first section of the small intestine) with an endoscope (a small, flexible tube with a light and a camera lens at the end)
  • endoscopy: a test that uses an endoscope to examine the inside of part of the digestive tract. Tissue samples from inside the digestive tract may also be taken for examination.
  • blood, stool, breath and stomach tissue tests: performed to detect the presence of H. pylori. Although some of the tests for H. pylori may occasionally give false-positive or false-negative results, these tests can detect the bacteria.

How we treat stomach and duodenal ulcers

Treatment may include:

  • Lifestyle changes: In the past, physicians advised parents to avoid feeding their children with ulcers spicy, fatty, or acidic foods. However, a bland diet is now known to be ineffective for treating or avoiding ulcers. No particular diet is helpful for most children with ulcers.
  • Some children and teenagers smoke, with or without their parent's knowledge or permission. Smoking has been shown to delay how fast their ulcers heal, and has been linked to the ulcer recurring.
  • Medications: Physicians may treat stomach and duodenal ulcers with several types of medications, including the following:
    • H2-blockers to reduce the amount of acid the stomach produces by blocking histamine, a powerful stimulant of acid secretion
    • proton pump inhibitors to more completely block stomach acid production by stopping the stomach's acid pump — the final step of acid secretion
    • mucosal protective agents to shield the stomach's mucous lining from the damage of acid, but do not inhibit the release of acid
    • When treating H. pylori, these medications or procedures are often used in combination with antibiotics.
  • Surgery. In most cases, anti-ulcer medicines heal ulcers quickly and effectively, and eradication of H. pylori prevents most ulcers from recurring.

However, children who don't respond to medication or who develop complications may require surgery. Types include:

  • vagotomy: a procedure that involves cutting parts of the vagus nerve (a nerve that transmits messages from the brain to the stomach) to interrupt messages sent through it, therefore, reducing acid secretion.

  • antrectomy: an operation to remove the lower part of the stomach (antrum), which produces a hormone that stimulates the stomach to secrete digestive juices. Sometimes a surgeon may also remove an adjacent part of the stomach that secretes pepsin and acid. A vagotomy is usually done in conjunction with an antrectomy.

  • pyloroplasty: a surgical procedure that may be performed along with a vagotomy, in which the opening into the duodenum and small intestine (pylorus) are enlarged, enabling contents to pass more freely from the stomach.

In the future, laparoscopic methods may also be standard surgical treatments. A laparoscopy is a test that uses a tube with a light and a camera lens at the end (laparoscope) to examine organs and check for abnormalities. Laparoscopy is often used during surgery to look inside the body and avoid making large incisions. Tissue samples may also be taken for examination and testing.