From the Research
Peptic ulcers in pediatric patients typically present with abdominal pain as the primary symptom, often located in the epigastric region, and the most recent evidence suggests that treatment with proton pump inhibitors, such as omeprazole, and antibiotics for H. pylori eradication is effective in healing and preventing recurrences 1. The pain may worsen with an empty stomach and improve after eating. Children might describe the pain as burning or gnawing, and it can sometimes wake them at night. Other common symptoms include:
- Nausea
- Vomiting
- Poor appetite
- Weight loss Unlike adults, children may not be able to clearly articulate their symptoms, making diagnosis challenging. Hematemesis (vomiting blood) or melena (black, tarry stools) can occur if the ulcer is bleeding. Younger children might show irritability, feeding refusal, or failure to thrive. The most common causes of pediatric ulcers are Helicobacter pylori infection and NSAID use, though stress-related ulcers can develop in critically ill children. Diagnosis typically requires endoscopy, and treatment depends on the underlying cause, often including acid suppressants like proton pump inhibitors (such as omeprazole 1-2 mg/kg/day), H2 blockers, and antibiotics for H. pylori eradication if present, as supported by studies such as 2 and 3. Parents should be advised to avoid giving NSAIDs to children with suspected ulcers and to seek immediate medical attention if signs of bleeding occur. Additionally, a study from 4 suggests that a quadruple therapy regimen including azithromycin, ofloxacin, bismuth, and omeprazole may be an effective and safe second-line treatment for H. pylori eradication.