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Peptic ulcers


Expert reviewer, Mr Stephen Pollard, Consultant Surgeon, July 2018
Next review due, July 2021

Peptic ulcers are sores that can develop in your gastrointestinal tract (GI tract), including your stomach, and usually happen when stomach acid damages the lining of your stomach and GI tract.

About peptic ulcers

The GI tract consists of your oesophagus, stomach and intestines and is where you break down and absorb food. You can develop peptic ulcers when the protective lining of this tract (the mucosa) is damaged or inflamed. This damage can happen for many reasons, but usually it’s because you:

  • have been infected by the bacterium Helicobacter pylori (H. pylori)
  • are regularly using a type of painkiller called NSAIDs (non-steroidal anti-inflammatory drugs) or taking other medicines, such as steroids

Normally the lining of your GI tract protects it from the chemicals and stomach acid that help you digest food. But if the amount of gastric acid increases, or the lining is weakened, the acid can damage your GI tract. This can then cause a peptic ulcer.

Both men and women of all ages can get peptic ulcers, but it’s generally more common in older people.

Types of peptic ulcers

Peptic ulcers can occur in various parts of your GI tract. So they may be:

  • oesophageal (along the tube that carries food from your mouth into your stomach)
  • gastric (in your stomach)
  • duodenal (in the first part of your small intestine, where food goes once it leaves your stomach)

Image showing the digestive system

Symptoms of peptic ulcers

If you have a peptic ulcer, you may not get any symptoms to start with. Instead symptoms may occur quite suddenly later on. This often happens if you’re older or taking NSAIDs (non-steroidal anti-inflammatory drugs).

If you do have symptoms, the most common one is abdominal (tummy) pain. You may also get pain in the middle of your back. If your ulcer is in your duodenum (duodenal ulcer), this pain tends to come on a couple of hours after a meal. Generally, it goes away when you eat again. You may also feel pain at night, which can wake you up, and when you have an empty stomach.

If you have an ulcer in your stomach (gastric ulcer), you’ll probably find that the pain comes on when you eat. Lying flat may relieve it. An ulcer in your oesophagus (oesophageal ulcer) may cause abdominal or lower chest pain, and make it difficult to swallow.

Indigestion is often a sign of a peptic ulcer, especially if you have it for more than a month. Indigestion can mean you:

  • feel sick (nauseous)
  • vomit
  • feel bloated
  • burp and are flatulent
  • have heartburn (gastro-oesophageal reflux) – when the contents of your stomach go back up your oesophagus

Some symptoms may mean you have another condition or you have a peptic ulcer that’s developed complications. If you have any of these symptoms, you should ask your GP for advice. They may include:

  • losing weight without dieting
  • seeing blood in your vomit
  • symptoms of anaemia (iron deficiency) like fatigue
  • having trouble swallowing
  • feeling full soon after you’ve started eating a meal

Diagnosis of peptic ulcers

Your GP will want to find out if you’ve got a peptic ulcer, and what’s causing it. This will help them start effective treatment as quickly as possible. Prompt treatment will reduce the risk of complications.

Your GP will ask you about your symptoms and medical history. They may also feel your abdomen to see if you have any tenderness or pain.

H. pylori (Helicobacter pylori) infection and long-term use of NSAIDs (non-steroidal anti-inflammatory drugs) are the main causes of peptic ulcers. Your GP will want to find out if either of these is causing your symptoms. You should tell the doctor if you’ve been taking over-the-counter NSAIDs (such as aspirin and ibuprofen) regularly.

H. pylori tests

There are different types of test that can show whether or not you have a H. pylori infection.

  • Faecal test. For this test, you’ll need to give your doctor a small sample of your faeces (about the size of a pea). It will be tested for H. pylori.
  • Blood test. Your doctor will take a small sample of blood to be sent to a lab and tested for antibodies against the H. pylori bacteria. Antibodies are produced by your immune system when it detects something that may be harmful. So, if you have these antibodies, it shows you are or have been infected with H. pylori.
  • Breath test. A breath test will be done at hospital. You’ll be asked to swallow a liquid containing a harmless radioactive chemical. If you’re infected with H. pylori, this chemical will be broken down by the bacteria and the gas carbon dioxide produced. After drinking the liquid you’ll be asked to breathe into a machine that measures the levels of radioactivity in the carbon dioxide. If this shows a high level, it probably means you’re currently infected with H. pylori.

You may not be able to have a breath or faecal test if you’ve recently been taking antibiotics or proton-pump inhibitors (PPIs).

Endoscopy

You may be referred for a gastrointestinal endoscopy (also called a gastroscopy), especially if you’re over 55, regularly use NSAIDs, or had peptic ulcers before. Your GP may also suggest an endoscopy if you’ve got any worrying symptoms, such as difficulty swallowing, unexplained weight loss, or persistent vomiting.

The doctor may want you to have the procedure on the same day they see you if you show signs of complications, such as vomiting blood.

You’ll be asked to give your consent for the endoscopy. It will be carried out in hospital or a treatment centre, and takes about 20 minutes, so you don’t normally need to stay in overnight. You’ll be given an anaesthetic throat spray to help you swallow a narrow, flexible, tube-like camera, called an endoscope. It can then be passed through your oesophagus, stomach and duodenum to show if there’s an ulcer.

If you have an ulcer, a biopsy (a small sample of tissue) is taken. This sample can be tested to see if your ulcer is caused by H. pylori. Rarely, the ulcerated area may be cancerous, so endoscopy provides a good opportunity to check that it isn’t. Your GP may have suggested the procedure if you’ve got a family history of stomach cancer. See our FAQ for more details on the link between peptic ulcers and cancer.

Treatment of peptic ulcers

It’s really important to get the right treatment as soon as possible if you’re diagnosed with a peptic ulcer. If treated properly, duodenal ulcers will heal in around four weeks and gastric ulcers in eight. You will usually be prescribed a medicine called a PPI (proton-pump inhibitor) to reduce the amount of acid your stomach produces. Treating the underlying cause means there’s less chance of your ulcer coming back. This can mean getting rid of the H. pylori (Helicobacter pylori) or stopping taking NSAIDs.

Self-help

Peptic ulcers can be caused or made worse by certain lifestyle factors, particularly smoking. So if you smoke, trying to quit may help reduce your symptoms. There’s some evidence that drinking too much alcohol contributes to peptic ulcers, so you could find it helps to cut down.

Although there’s no special diet plan that you should follow if you’ve got a peptic ulcer, healthy eating is very important. This means eating a range of foods and trying to stay a healthy weight. If your ulcer is caused by H.pylori infection, eating more fruit and vegetables and less salt is a good idea.

Try to avoid ‘triggers’ that you know make your symptoms worse. It depends on the individual, but these may include:

  • certain spices
  • highly flavoured foods
  • fatty foods
  • chocolate
  • tomatoes
  • coffee

Some people find eating bland or milky foods reduce their symptoms. Eating smaller portions, and having your evening meal at least three hours before you go to bed, may make a difference too.

Medicines

You can take antacids to help relieve indigestion and other symptoms, but your doctor may also prescribe medicines to treat the cause of your ulcer.

H. pylori-related ulcers

If your peptic ulcer is caused by a H. pylori infection, you’ll be prescribed a course of antibiotics to clear the infection. You’ll probably need to take the antibiotics for between one and two weeks. The doctor may suggest you take several types at the same time if you’ve built up a resistance to antibiotics from taking them before.

You’ll also be given medicines alongside the antacids and antibiotics, that help to prevent further damage to your GI tract and give your ulcer the chance to heal. These groups of medicines work by decreasing how much stomach acid you produce.

  • PPIs (proton-pump inhibitors). You may be asked to take a PPI for around four to eight weeks.
  • H2-receptor antagonists. If treatment with a PPI doesn’t work particularly well for you, your doctor may prescribe an H2-receptor antagonist instead.

NSAID (non-steroidal anti-inflammatory drug) related ulcers

If your ulcer is caused by using NSAIDs, you’re likely to be advised to stop taking them so that your ulcer can heal. You’ll also be given a PPI or H2-receptor antagonist to decrease acid production. Overall, these medicines are safe to use but may cause you some temporary side-effects such as diarrhoea or nausea (feeling sick).

Your GP can help you reduce the dose and use them only when you really need to, not regularly. Or there may be an alternative painkiller or different type of NSAID you could take that is less likely to cause an ulcer.

Your doctor will want to monitor you to check if your ulcer is healing. They’ll also want to make sure any H.pylori infection has cleared up if this is what caused the ulcer. They may repeat the H.pylori tests or suggest another endoscopy, especially if your symptoms aren’t improving. Your GP may refer you to a specialist if your ulcer is not responding to treatment or keeps coming back.

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Causes of peptic ulcers

Helicobacter pylori

The most common cause of peptic ulcers is a stomach infection caused by the bacteria Helicobacter pylori (H. pylori). Lots of people in the UK are infected with H. pylori, but generally the infection doesn’t cause any problems. You may get the bacteria from other people and through food. If you’re infected, it’s likely that this happened when you were a child. With less overcrowding and better hygiene, these days not as many children get the infection or transmit it to someone else. Good personal hygiene and care when you’re handling food will help make sure you don’t pass it on, or get infected yourself. The risk of transmitting the bacteria also increases with age.

H. pylori infection is the cause in around nine out of 10 people with duodenal ulcers and eight out of 10 people with gastric ulcers. They happen because the infection can damage the lining of your GI tract. It does this by:

  • causing inflammation
  • interfering with acid production – sometimes H. pylori can disrupt the mechanism that switches off acid production, so your stomach then produces too much acid

Non-steroidal anti-inflammatory drugs (NSAIDs)

The second most common cause of peptic ulcers is taking NSAIDs frequently or over a long period of time. Around two out of 10 gastric ulcers and one out of 10 duodenal ulcers are caused by this. Most people can take NSAIDs safely, but they can cause problems if you take them regularly, particularly as you get older. Although NSAIDs are useful for treating pain, a disadvantage is that they can also cause the lining of your GI tract to become weak. This means that damage and peptic ulcers are more likely to happen.

Other factors that may increase your risk of getting a peptic ulcer include:

  • smoking
  • other people in your family having peptic ulcers
  • getting older
  • having a long stay in hospital intensive care
  • surgery or serious injury
  • certain medicines, including corticosteroids
  • infections and conditions such as HIV and Crohn’s disease

Complications of peptic ulcers

If you get treatment for your peptic ulcer, the outcome is usually very good and complications aren’t very common. However, if you haven’t had any treatment, or your ulcer has gone unnoticed for a while, complications may develop. There’s a particular risk if you’re older and if you’re taking anticoagulants such as aspirin that stop your blood clotting. Complications include:

  • bleeding
  • perforation
  • obstruction

The most common of these is bleeding, especially if your ulcer is linked to NSAIDs. It happens if your ulcer wears down (erodes) into any underlying arteries or veins (blood vessels). If your ulcer is bleeding, you’re likely to notice that:

  • you might vomit blood – this can be bright red or dark like coffee grounds
  • your faeces is black and sticky

If you lose a lot of blood, you could develop anaemia (iron deficiency).

You should get urgent medical advice if you have any of these symptoms, particularly if you’re older. You may need emergency surgery. But this can depend on how much blood you’ve lost. The surgeon may be able to stop the bleeding using an endoscope rather than open surgery. It’s also possible to treat bleeding with a high dose of PPIs.

It’s possible that your ulcer could erode through the lining of your stomach or duodenum leading to either perforation or penetration. Perforation is when the ulcer erodes through the wall of your stomach or duodenum, causing inflammation of your abdominal lining (peritonitis) and a potentially serious infection. Your stomach will feel rigid and sore. Penetration is when your ulcer completely erodes all the way through your stomach or duodenal wall and into other organs. If this happens, you’ll have severe stomach pain.

The least common complication is obstruction of food passing from your stomach into your duodenum during digestion (this is known as pyloric stenosis). It happens if tissue surrounding your ulcer becomes hard and thick (scars) as your body repeatedly tries to repair damage caused by it. Obstruction may cause you to:

  • feel sick
  • vomit after having a meal
  • lose weight
  • become dehydrated

Depending on the cause of the obstruction, it can be treated using endoscopy PPIs (proton-pump inhibitors).

  • bleeding
  • perforation
  • obstruction

Frequently asked questions

  • It’s important to understand the relationship between peptic ulcers and stomach cancer. Peptic ulcers don’t turn into or cause cancer. But H. pylori infection does increase the risk of getting stomach cancer later on. So if your peptic ulcer is caused by the H.pylori bacteria, it can mean you’re at greater risk of developing this sort of cancer. There is a particular risk if you have the infection for a long time. Your doctor will want to treat it as soon as possible.

    Some of the symptoms of a peptic ulcer, like indigestion, unexplained weight loss, vomiting and problems swallowing, can also be signs of stomach cancer. An endoscopy and biopsy of the ulcer are likely to spot any cancer.

  • It’s hard to say. Strenuous exercise and some vigorous movements of your abdomen may cause the same sort of symptoms you can get from a peptic ulcer. Heartburn, nausea, vomiting and stomach pains are commonly reported by runners, for instance. So certain activities could add to your symptoms. Avoiding solid food for several hours before you exercise may help.

    There’s some evidence that moderate activity can reduce the risk of developing a peptic ulcer, especially if it’s part of a healthy lifestyle. But doing too much exercise may have the opposite effect. It may slow the flow of blood to the lining of your GI tract and make it more likely you’ll take NSAIDs regularly for aches and pains.



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Related information

    • Upper gastrointestinal surgery. Oxford handbook of clinical surgery. 4th ed. (online). Oxford Medicine Online. oxfordmedicine.com, published May 2013
    • Nutrition in gastrointestinal diseases. Oxford handbook of nutrition and dietetics 2nd ed. (online). Oxford Medicine Online. oxfordmedicine.com, updated December 2015
    • Peptic ulcer disease. BMJ Best Practice. bestpractice.bmj.com, last updated November 2017
    • Dyspepsia – proven peptic ulcer. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised September 2017
    • Peptic ulcer disease. Medscape. emedicine.medscape.com, updated January 2017
    • Gastrointestinal medicine. Oxford handbook of general practice 4th ed. (online). Oxford Medicine Online. oxfordmedicine.com, published March 2014
    • Gastroenterology. Oxford handbook of geriatric medicine. 2nd ed. (online). Oxford Medicine Online. oxfordmedicine.com, published August 2012
    • Gastroenterology. Oxford handbook of clinical medicine. 10th ed. (online). Oxford Medicine Online. oxfordmedicine.com, published July 2017
    • Peptic ulcer disease. PatientPlus. www.patient.info/patientplus, last checked February 2015
    • Gastro-oesophageal reflux disease and dyspepsia in adults: Investigation and management. National Institute for Health and Care Excellence (NICE), November 2014. www.nice.org.uk
    • Sverdén E, Brusselaers N, Wahlin K, et al. Time latencies of Helicobacter pylori eradication after peptic ulcer and risk of recurrent ulcer, ulcer adverse events, and gastric cancer: a population-based cohort study. Gastrointest Endosc 2017 doi: 10.1016/j.gie.2017.11.035
    • Test and treat for Helicobacter pylori (HP) in dyspepsia. Quick reference guide for primary care: for consultation and local adaptation. Public Health England. https://www.gov.uk/government/publications/helicobacter-pylori-diagnosis-and-treatment, last reviewed October 2016
    • Beg S, Ragunath K, Wyman A, et al. Quality standards in upper gastrointestinal endoscopy: a position statement of the British Society of Gastroenterology (BSG) and Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland (AUGIS). Gut 2017; 66(11):1886–99. doi:10.1136/gutjnl-2017-314109
    • Antacids. NICE British National Formulary. https://bnf.nice.org.uk/treatment-summary/antacids.html, accessed 8 February 2018
    • Dyspepsia and GORD. GP Update Handbook (online). GP Update Ltd, gpcpd.com, accessed 2 February 2018
    • Proton pump inhibitors. NICE British National Formulary. https://bnf.nice.org.uk/treatment-summary/proton-pump-inhibitors.html, accessed 8 February 2018
    • H2-receptor antagonists. NICE British National Formulary. https://bnf.nice.org.uk/treatment-summary/h2-receptor-antagonists.html, accessed 8 February 2018
    • Surgery. Oxford handbook of clinical medicine. 10th ed. (online). Oxford Medicine Online. oxfordmedicine.com, published July 2017
    • Risk factors and causes of stomach cancer. Macmillan Cancer Support. www.macmillan.org.uk, reviewed October 2016
    • NSAIDs – prescribing issues. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised July 2015
    • Gastrointestinal symptoms during exercise. Brukner & Khan’s Clinical Sports Medicine (4th ed. online) McGraw-Hill Medical. csm.mhmedical.com, published 2012
    • Shephard R. Peptic ulcer and exercise. Sports Med 2017; 47(1):33–40. doi: 10.1007/s40279-016-0563-4
  • Reviewed by Dylan Merkett, Bupa Health Content Team.
    Expert reviewer, Mr Stephen Pollard, Consultant Surgeon, July 2018
    Next review due, July 2021

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