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Peptic ulcers

Key points

  • A peptic ulcer is an area of damage to the lining of either your oesophagus, stomach or duodenum
  • Peptic ulcers are caused by stomach acid. They are more likely to occur if you’re infected with a bacterium called Helicobacter pylori.
  • Another cause is taking anti-inflammatory drugs (such as steroids and non-steroidal anti-inflammatory drugs).
  • Peptic ulcers are managed with medicines and treating any underlying cause, to help your ulcers heal and prevent them coming back.

Ulcers of the lower part of the gullet (oesophageal ulcers), the stomach (gastric ulcers) and the first part of the small intestine (duodenal ulcers) are also known as peptic ulcers. Peptic ulcers can affect people of any age, but they are more common as you get older. They affect men and women equally.

Animation - how a peptic ulcer develops

About peptic ulcers

Your stomach produces acid to help you digest and sterilise food. The lining of your stomach and first part of your small bowel have a layer of mucus that protects them from the acid. If this protection mechanism doesn't work properly, or if acid refluxes back up into your gullet, the acid can eat into the lining of your oesophagus, stomach or duodenum and cause an ulcer.

The size of peptic ulcers can vary from five millimetres (mm) to several centimetres (cm) across. If the damaged area is smaller than 5mm across then it’s called an erosion.

Symptoms of peptic ulcers

You may not have any symptoms at all if you have a peptic ulcer. However, the most common symptom is pain in your abdomen (tummy), just below your breastbone. This pain is often described as burning or gnawing. It may extend to your back. It usually comes on after eating – often one to two hours after a meal – and may come and go for several days or weeks. The pain is worse at night when your stomach is empty.

Other symptoms may include:

  • heartburn
  • a poor appetite
  • feeling bloated
  • feeling sick or vomiting food or blood
  • burping

It's important to see your GP if you have:

  • lost weight without dieting
  • seen blood in your vomit or bowel movements
  • sudden, severe abdominal pain

These symptoms may be caused by other problems than a peptic ulcer. If you have any of these symptoms, see your GP for advice.

Causes of peptic ulcers

Helicobacter pylori infection

The most common cause of peptic ulcers is a stomach infection caused by a bacterium called Helicobacter pylori (H. pylori). The infection inflames your stomach lining and interferes with the mechanism which switches off acid production, causing your stomach to produce too much acid. The infection is quite common; around nine out of 10 people with duodenal ulcers and more than seven out of 10 people with gastric ulcers have H. pylori infection.

Non-steroidal anti-inflammatory drugs (NSAIDs)

The second most common cause of peptic ulcers is taking steroids or non-steroidal anti-inflammatory drugs (NSAIDs). Examples of NSAIDs include aspirin, ibuprofen, naproxen and diclofenac. Most people can take these safely, but if you take NSAIDs over a long period of time, they can damage the mucus lining in your stomach. Gastric ulcers are almost always linked with NSAID use.

Other causes

You’re more likely to get a peptic ulcer if you smoke, drink excessive alcohol or have a family history of peptic ulcers. Family risk is probably caused by H. pylori passing from one family member to another rather than an inherited risk.

Experts previously thought that stress could cause a peptic ulcer. However, stress is now only considered to be important if it's the result of a major operation or trauma.

Complications of peptic ulcers

Complications of a peptic ulcer include the following.

  • Bleeding. A peptic ulcer can erode into the wall of a blood vessel and bleed. If this happens suddenly, you may vomit blood, which may be bright red or look like coffee grounds (dark brown bits of clotted blood). You might also have dark faeces that look like tar and have a strong odour.
  • Anaemia. If the ulcer causes light bleeding that lasts for a long time, it can lead to iron-deficiency anaemia.
  • Perforation. A peptic ulcer may push through the wall of your stomach or duodenum. This is called a perforation – it causes severe pain and you will need emergency surgery.
  • Obstruction. Rarely, long-term inflammation in the wall of your oesophagus causes scarring and narrowing, making it difficult to swallow food. Scarring from a duodenal ulcer can cause an obstruction which may cause nausea, weight loss or cause you to vomit.

Diagnosis of peptic ulcers

Your GP will ask about your symptoms and medical history. If your doctor thinks you may have a peptic ulcer, you may be asked to have the following tests.

H. pylori test

Your doctor may take a blood test, or ask you to provide a sample of your faeces. The samples will be sent to a laboratory for testing.

Alternatively, your doctor may arrange for you to have a breath test (called the carbon-13 urea breath test). You will be asked to swallow a liquid containing a low level of harmless radioactive material. H. pylori breaks down the substance into radio-labelled carbon dioxide gas. You will be asked to breathe into a special machine which measures the levels of carbon dioxide gas. High carbon dioxide levels indicate H. pylori infection.

Endoscopy

Your GP may arrange for you to have a gastrointestinal endoscopy (also called a gastroscopy). This procedure is done using a narrow, flexible, camera called an endoscope that you swallow and is passed through into your oesophagus, stomach and duodenum. It allows your doctor to look inside your oesophagus, stomach and duodenum and take a biopsy (a small sample of tissue). This sample can be tested for H. pylori and to check that the lump or ulcer isn’t cancerous.

Treatment of peptic ulcers

Self-help

There are lifestyle changes that you can make to help your ulcers heal and prevent them coming back. These include:

  • not having food and drink that makes your symptoms worse, such as spicy foods and alcohol
  • stopping smoking
  • stop taking NSAIDS, your GP or pharmacist can suggest alternative medicines

Medicines

Your doctor will prescribe medicines called proton pump inhibitors (PPIs) to reduce the amount of acid your stomach produces and help the ulcer to heal. This is the main medicine prescribed to treat ulcers.

Medicines include omeprazole, esomeprazole, lansoprazole, pantoprazole and rabeprazole.
PPIs reduce acid production in your stomach, allowing your ulcer to heal. You will need to take the medicines for about six to eight weeks.

Your doctor may prescribe other medicines such as H2 blockers if you don’t respond to treatment with PPIs. Discuss your treatment options with your GP.

If you’re taking NSAIDS for medical reasons (for example, you need to take a daily aspirin to prevent heart disease), your doctor may prescribe PPIs long-term to control your symptoms and prevent gastric ulcers.

Treating H. pylori infection

If tests confirm that you have H. pylori, you will also be prescribed a course of antibiotics. This is given in combination with a PPI and usually consists of two antibiotics (such as amoxicillin or clarithromycin and metronidazole) that you take for seven to 14 days. Treating the H. pylori infection should allow your ulcer to heal and prevent it from coming back. Your GP will test you again about four weeks later to make sure the infection has gone.

Always read the patient information leaflet that comes with your medicine and take your antibiotics as directed by your doctor. Don't stop taking them early, even if your symptoms improve. If you have any questions, ask your pharmacist or GP for advice.

 

Reviewed by Natalie Heaton, Bupa Health Information Team, August 2013.

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  • This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals. Photos are only for illustrative purposes and do not reflect every presentation of a condition. The content is intended only for general information and does not replace the need for personal advice from a qualified health professional. For more details on how we produce our content and its sources, visit the about our health information page.

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