Overview
The stomach makes strong acid to digest food, and a layer of mucus protects its lining. A peptic ulcer forms when that protection breaks down and acid eats into the lining.
An ulcer in the stomach is called a gastric ulcer, and one in the duodenum, the first part of the small intestine, a duodenal ulcer. Both are treated in much the same way.
Symptoms
- A burning or gnawing pain in the upper tummy, often the main symptom
- Pain worse at night or between meals, easing briefly after eating or an antacid
- Indigestion and heartburn
- Feeling full too soon while eating
- Bloating, burping, feeling sick and vomiting
- Sometimes no pain at all, with bleeding or anaemia as the first sign
When to see a doctor
See a doctor in the next few days for indigestion or upper tummy pain that keeps coming back or does not settle with pharmacy medicines, for repeated vomiting, for weight loss without trying, or for looking pale and feeling unusually tired.
Causes
Most ulcers are caused by infection with , a germ that lives in the stomach lining and weakens its protective layer. Many people carry it without ever knowing.
The other common cause is regular use of anti-inflammatory painkillers such as ibuprofen, diclofenac or aspirin, which reduce the lining's defences. Steroid tablets and rare conditions that make the stomach produce far too much acid can also be responsible.
Risk factors
- Infection with the H. pylori germ
- Taking anti-inflammatory painkillers often, or in higher doses
- Taking those painkillers along with steroid tablets or blood thinners
- Older age
- Smoking, chewing tobacco or drinking a lot of alcohol
- A previous ulcer
Complications
An ulcer can bleed, slowly enough to cause iron deficiency anaemia or fast enough to be an emergency. It can wear right through the wall of the stomach, spilling contents into the abdomen and causing a severe infection called peritonitis. Scarring can block the outlet of the stomach, so food comes back up. Untreated H. pylori infection also raises the risk of stomach cancer.
Prevention
- Using anti-inflammatory painkillers only when needed, and asking a doctor about safer options for long-term pain
- Telling every doctor about any previous ulcer before a new painkiller is started
- Getting tested and treated for H. pylori when a doctor advises it
- Stopping tobacco, cutting down on alcohol, and not ignoring indigestion that keeps returning
Diagnosis
A doctor asks about the pain and about painkillers and other medicines, and examines the tummy. The H. pylori germ is looked for with a breath, stool or blood test.
A gastroscopy, a thin camera passed through the mouth, shows the ulcer directly, allows small samples to be taken and can treat bleeding at the same time. It is advised more readily for older people and for anyone with warning signs such as black stools, difficulty swallowing or weight loss.
Treatment
If H. pylori is found, treatment is a combination of together with a medicine that strongly reduces stomach acid, taken for a set number of days. A test is often repeated afterwards to confirm the germ has gone.
If an anti-inflammatory painkiller is the cause, the doctor usually stops or changes it and prescribes an acid-reducing medicine for about one to two months while the ulcer heals. Where such a painkiller cannot be avoided, a protective medicine may be added.
A bleeding ulcer is treated in hospital during a gastroscopy, and a hole in the stomach wall needs surgery. Stopping tobacco helps ulcers heal.
Myths and facts
Things people often say about this. Open each one to see what is true.
Myth“Spicy food and too much tension are what cause ulcers.”What is true?
Fact
The two usual causes are infection with the H. pylori germ and regular use of anti-inflammatory painkillers such as ibuprofen or aspirin. Stress and spicy food do not cause ulcers, although they can make the symptoms feel worse. Treating the real cause is what allows the ulcer to heal.
Myth“Once you have an ulcer you must live on milk, curd and plain khichdi.”What is true?
Fact
Researchers have not found that diet plays an important part in causing, preventing or treating peptic ulcers, and most people do not need a special diet. It is sensible to cut down on anything that clearly sets your symptoms off, but bland food alone will not heal an ulcer.
Myth“The pain has gone after a few antacids, so the ulcer is cured.”What is true?
Fact
Acid-reducing medicines ease the pain quickly, but the sore takes weeks to heal, and if the H. pylori germ is still there or the painkiller is still being taken, the ulcer usually comes back. That is why the full course is prescribed even when you feel well.
Myth“Painkillers for knee or back pain are safe to keep taking with an ulcer.”What is true?
Fact
Anti-inflammatory painkillers are one of the two main causes of ulcers and can make an existing one bleed. Anyone who has had an ulcer and needs regular pain relief should ask a doctor, because there are other options and protective medicines.
Questions to ask your doctor
Tick the ones you want answered and take them with you.
Common questions
How did I catch the H. pylori germ?
Many people pick it up in childhood and carry it for years without symptoms, so it is usually impossible to say when or where. It is common worldwide. What matters is that it can be found with a simple test and cleared with a course of treatment.
Will the ulcer come back after treatment?
Ulcers are much less likely to return once the H. pylori germ has been cleared and the painkiller responsible has been stopped or changed. They do come back in people who keep taking anti-inflammatory painkillers, who continue to smoke, or whose infection was never fully treated.
Is an ulcer the same as cancer?
No. An ulcer is a sore, and most are not cancer. However, a gastric ulcer can occasionally look like a cancer on a scan or camera test, and long-standing untreated H. pylori infection raises the risk of stomach cancer. That is why samples are sometimes taken during a gastroscopy and why a repeat check may be advised.
Can I drink tea and coffee while the ulcer heals?
Food and drink do not heal or cause ulcers, so there is no fixed list to avoid. Strong tea, coffee, alcohol and very spicy food can make the burning feel worse for some people, and it is reasonable to cut down on whatever clearly upsets you while the medicine does its work.
