Peptic ulcer

Peptic ulcers are small holes in the lining of your stomach or gut. There are several types of peptic ulcer and they are named according to their location.

  • Duodenal ulcers which are in the upper part of the small intestine (gut) near the stomach are the most common, and are more likely in men aged between 30 and 50 years.
  • Stomach (gastric) ulcers most often affect middle aged or elderly people.

Causes

Bacterial infection

Stress was previously considered the main reason people developed ulcers. More recently, studies have shown that about 90% of duodenal ulcers and 70% of gastric ulcers are caused by infection with a bacteria called Helicobacter pylori (H. pylori). The infection is very common and is usually picked up in childhood. While many people are infected, only some will go on to have ulcers.

The H. pylori bacteria make a substance that damages the mucous lining of the stomach so that it can be damaged by acids that break down food during digestion. The bacteria also make the body produce more acid which makes the problem even worse. Anti-inflammatory drugs can work in a similar way, leaving the stomach open to attack from digestive acids.

Overuse of anti-inflammatory drugs

After H. pylori, the next most common cause of ulcers is taking a lot of anti-inflammatory drugs (such as aspirin, ibuprofen or other non-steroidal anti-inflammatory drugs [NSAIDs]), usually for fever, headache or arthritic conditions. People who take anti-inflammatory drugs long term for pain relief should talk to their doctor about ways to protect themselves from developing ulcers.

Other causes:

  • Some people have excess acid production in the stomach which can cause damage to the stomach lining.
  • Smoking increases the risk of getting an ulcer and makes healing slower.
  • While emotional stress is no longer considered a cause of ulcers, it can make the pain worse. Physical stress such as major surgery or burns, however, can increase the risk of gastric ulcers.
  • Alcohol and coffee are not considered to be causes of ulcers but they may stimulate acid production in the stomach and make symptoms worse. However, people with liver damage from drinking or other problems are more likely to get ulcers.

Symptoms

Duodenal ulcers cause heartburn and pain in the middle abdomen. The pain is relieved by food, so some people with this type of ulcer put on weight. The pain is usually worse when you are hungry, eat acidic food, drink coffee or alcohol or take an aspirin. Night pain is common, but vomiting, severe pain and blood in the stools are rare and should be reported to your doctor.

Gastric ulcers usually cause heartburn and indigestion. There can be a gnawing pain and a feeling of bloating in your upper abdomen which can be worse after a large meal. Some people lose weight.

See a doctor immediately if you: 
- have black tarry stools
- vomit blood
- feel dizzy or faint when you stand up
- feel sharp, sudden, severe pain
- vomit what you have just eaten.

Complications

Ulcers are not usually life-threatening. However, in some people they may bleed, perforate (make a hole in the stomach or the duodenum so food and bacteria go into the abdomen) or the area around them may become scarred, blocking up the intestines.

Diagnosis

An x-ray may be taken of your stomach and gut, an endoscope (an instrument for viewing the inside of the body) may be put into your stomach to look for ulcers, and tests may be done on your stomach acids and stools. You may also be asked to blow into a special tube or have your blood tested to see if you have H. pylori infection.

Treatment

Twenty years ago peptic ulcers used to cause much pain and suffering. Now, we have much better treatment options and medications to treat peptic ulcers. These include:

  • medications to reduce the amount of acid produced in the stomach
  • medications to protect the lining of the stomach from further erosion
  • therapy to eradicate H. pylori infection.

If you have H. pylori infection you will have a course of antibiotics and other drugs (combination therapy or triple therapy) to clear the infection. Different eradication therapies for H. pylori have different time requirements but treatment is usually only needed for about two weeks, and is very effective.

Occasionally, surgery may be needed to stop bleeding or to fix ulcers completely.

Self care

Lifestyle measures which may help include:

  • eating a well-balanced diet and having regular meals
  • antacids can offer temporary relief and may help protect the lining of the stomach
  • not taking aspirin or other anti-inflammatory drugs if possible
  • stopping smoking
  • avoid eating too much, having late night snacks or skipping meals (don't get hungry)
  • identify and avoid food and drinks that make the pain worse (may include alcohol, coffee)
  • reducing stress
  • follow other recommendations given by your doctor.

Learn more

Stomach Ulcers NHS Choices UK, 2013
Peptic Ulcer - a patient's guide Family Doctor NZ
Peptic Ulcers Auckland Gastroenterology Associates, 2009

Credits: Health Navigator. Reviewed By: Health Navigator