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9 years old with 4 plus years history of doudenum ulcer

Posted by annietran0419 @annietran0419, Apr 28 8:09pm

Hi, I’m looking for guidance regarding my 9-year-old son.
Previously diagnosed with Eosinophilic Esophagitis
Has had a non-healing duodenal ulcer for over 4 years
On H2 blockers long-term
On a strict food elimination diet since August 2025
3 follow-up biopsies show no EoE
Negative for Helicobacter pylori infection and Zollinger-Ellison syndrome
No NSAID or known medication cause
Recent imaging showed inflammation on T2-weighted scan (cause unclear)
Current decision:
His doctor is recommending either oral steroids or Dupixent. An elemental formula diet was also discussed, but this feels very difficult for a 9-year-old.
Questions:
What could cause a duodenal ulcer that hasn’t healed after 4+ years with these negative findings?
Can EoE be in remission on biopsy but still cause ongoing GI inflammation elsewhere?
Could this be food-triggered inflammation (e.g., gluten or other sensitivities) even without eosinophils?
For those with similar cases, how did you decide between steroids vs Dupixent vs elemental diet?
What additional tests or next steps would you recommend before starting these treatments?
Thank you for any insight or shared experiences

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cheyne | @cheyne | Apr 29 4:05pm

Hi,
I had similar problems at about the same age, 60 some years ago. Steriods would be my last choice, instead going with the elemental diet. Back then medicine was not as advanced as it is now. I was given a container of powder to be mixed with water and down the hatch. Not the best thing I have every had to stomach but whatever it was did the job. Even today the digestive system seems still to be a mystery, they know how it works but not what triggers some of the symptoms. In my case they have no idea what is destroying my digestive system.
I only remebered my ulcer when I saw your heading. It is most unlikely it has anything to do with my current plight as I had 40 odd good year without problems inbetween.
Good luck
Cheers

REPLY
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Mentor
Janell, Volunteer Mentor | @jlharsh | Apr 29 4:16pm

Hi @annietran0419. I am so, so glad you found Mayo Clinic Connect. You have landed where members share information and encouragement. It has to be difficult to walk with your son through this struggle trying to heal his stubborn duodenum ulcer.

Mayo Clinic has information you may find helpful as you wait for others to comment. I want to particularly draw attention to a section, ‘Ulcers that don't heal’.
- Peptic ulcers that don't heal with treatment are called refractory ulcers. Reasons for an ulcer not healing include:
* Not taking medicines as prescribed.
* Having a type of H. pylori that resists antibiotics.
* Often using pain relievers, such as NSAIDs, that increase the risk of ulcers.
* Less often, refractory ulcers may be a result of: A lot of stomach acid, such as happens in Zollinger-Ellison syndrome, an infection other than H. pylori, or stomach cancer.
- Other conditions that may cause ulcerlike sores in the stomach and small intestine, such as Crohn disease.

I will drop a link to the entire overview if you have not seen it:
- Mayo Clinic Peptic Ulcer Overview
https://www.mayoclinic.org/diseases-conditions/peptic-ulcer/symptoms-causes/syc-20354223
You may also find it helpful to search for key words from the Connect home page to learn more.

I am a patient of Mayo Clinic who has struggled through what they have called a marathon of helping my quality of daily living. I cannot say enough about their integrative approach to problem solve and find solutions. I don’t know where you live and how feasible it would be to visit but I do notice their overview lists providers at their MN location specializing in treating peptic ulcers. For me, I reached a point that it wasn’t worth not making the 7-hour car ride. It is straightforward to pursue an appointment if you are interested.

Connect with Mayo Clinic for an appointment here: http://mayocl.in/1mtmR63

How does your son physically feel overall, how about emotionally? How are you?

REPLY
1 reply
Profile picture for annietran0419
annietran0419 | @annietran0419 | Apr 30 7:42pm
In reply to @jlharsh "Hi @annietran0419. I am so, so glad you found Mayo Clinic Connect. You have landed where..." + (show)
Profile picture for Janell, Volunteer Mentor @jlharsh

Hi @annietran0419. I am so, so glad you found Mayo Clinic Connect. You have landed where members share information and encouragement. It has to be difficult to walk with your son through this struggle trying to heal his stubborn duodenum ulcer.

Mayo Clinic has information you may find helpful as you wait for others to comment. I want to particularly draw attention to a section, ‘Ulcers that don't heal’.
- Peptic ulcers that don't heal with treatment are called refractory ulcers. Reasons for an ulcer not healing include:
* Not taking medicines as prescribed.
* Having a type of H. pylori that resists antibiotics.
* Often using pain relievers, such as NSAIDs, that increase the risk of ulcers.
* Less often, refractory ulcers may be a result of: A lot of stomach acid, such as happens in Zollinger-Ellison syndrome, an infection other than H. pylori, or stomach cancer.
- Other conditions that may cause ulcerlike sores in the stomach and small intestine, such as Crohn disease.

I will drop a link to the entire overview if you have not seen it:
- Mayo Clinic Peptic Ulcer Overview
https://www.mayoclinic.org/diseases-conditions/peptic-ulcer/symptoms-causes/syc-20354223
You may also find it helpful to search for key words from the Connect home page to learn more.

I am a patient of Mayo Clinic who has struggled through what they have called a marathon of helping my quality of daily living. I cannot say enough about their integrative approach to problem solve and find solutions. I don’t know where you live and how feasible it would be to visit but I do notice their overview lists providers at their MN location specializing in treating peptic ulcers. For me, I reached a point that it wasn’t worth not making the 7-hour car ride. It is straightforward to pursue an appointment if you are interested.

Connect with Mayo Clinic for an appointment here: http://mayocl.in/1mtmR63

How does your son physically feel overall, how about emotionally? How are you?

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@jlharsh : thank you. I reached out to the clinic. They called me today but I were at work. I will call them back tomorrow.
My son is doing okay. He don't eat as much as other kids his age probably because the ulcer but otherwise, he is doing well. Thanks for asking

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