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Peptic ulcersPublished by BUPA's health information team, healthinfo@bupa.com, December 2007. This factsheet is for people who have peptic ulcers, or who would like information about them. A peptic ulcer is an area of damage to the lining of either the stomach or the small intestine.
About peptic ulcersThe stomach produces acid to help with digestion; the lining of the stomach and first part of the small intestine (duodenum) have ways to protect themselves naturally from this. When these stop working the acid can eat into the stomach lining causing a peptic ulcer. Peptic ulcers are usually about 1 to 2cm across and they look like large mouth ulcers. Ulcers of the small intestine are known as duodenal ulcers. Duodenal ulcers affect about one in 10 people at some point in their lives, usually between the ages of 45 and 65. Stomach ulcers are less common, and usually affect people aged over 65.
SymptomsSome people with a peptic ulcer have no symptoms. However, many people have upper abdominal pain usually just below the breastbone (sternum). You may sometimes feel a pain in your back. The pain usually comes on an hour or two after eating and can be relieved by more food or antacid medicine. It may also wake you at night. Other symptoms may include:
You should see your doctor if you have:
These symptoms may be caused by problems other than peptic ulcers. You should visit your GP for advice. ComplicationsMost people who have a peptic ulcer don't have any complications. However, possible complications include the following. BleedingOccasionally ulcers can cause the lining of the stomach or duodenum to bleed. If this happens, you will need hospital treatment. A bleeding ulcer will give symptoms that include:
If you have any of these symptoms, you should see a doctor immediately. AnaemiaIf the bleeding from the ulcer is slow, you might not get blood in your vomit or faeces. However, you may develop anaemia. This is a condition where there are not enough red blood cells to carry oxygen around the body. PerforationRarely, the ulcer may erode very deeply into the wall of the stomach or duodenum, leaving a hole into the abdomen. This causes severe pain and needs emergency surgery. However, because treatment with medicine is usually successful, surgery is now rarely needed for peptic ulcers. CausesThe following are the most important causes of peptic ulcers.
Being under a lot of stress is widely thought to cause ulcers, but this has not been proven. It could be that people under lots of stress are more likely to smoke and drink too much. DiagnosisIf you have a suspected peptic ulcer, your doctor may recommend some of the following tests to diagnose and to decide how to treat you. H. pylori testAs H. pylori is the commonest cause of a peptic ulcer, your doctor may test for and prescribe medicines to remove the bacteria if it's found to see if your symptoms improve. Testing for H. pylori is done with either a breath, blood or faeces (stool) test. For the breath test, you are given a liquid to swallow that is broken down by the H. pylori bacteria to produce a gas. Your breath is then tested for this gas by a machine. If the gas is found, H. pylori are present. For the other tests, a sample of blood or your faeces is sent off to a laboratory for analysis. If you have been taking an anti-ulcer medicine called a proton pump inhibitor (see Treatment), the breath and faeces test won't be accurate until two weeks after stopping the medicine. EndoscopyIf you have a suspected peptic ulcer, your doctor may arrange a gastro-intestinal endoscopy. Not everyone who has abdominal pain needs one, so your doctor may decide to investigate you in one of the other ways first. However, endoscopy is the only way to be certain whether you have a peptic ulcer. During the procedure, a flexible, tube-like instrument called a gastroscope is passed through the mouth and into the stomach, usually under sedation in hospital. The procedure usually lasts a few minutes. With the instrument the doctor can see the lining of your stomach, and can take a sample of stomach lining or a biopsy with an instrument that is passed down through the tube. This sample is either sent to a laboratory and examined under a microscope, or directly tested for H. pylori. Barium mealThis involves swallowing a drink containing barium (a substance that shows up on X-rays). X-ray images of your abdomen then show the inside of your bowel more clearly. TreatmentSelf-helpThere are lifestyle changes that you can make to help your ulcers heal and prevent them coming back. These self-help measures include:
MedicinesThere are two main groups of medicines available to treat peptic ulcers. Both reduce acid production in the stomach, allowing the ulcer to heal. They can also both be used long-term to prevent re-occurrence. The first group are called H2-blockers. Examples include ranitidine (eg Zantac) and cimetidine (eg Tagamet). These are effective for most people with a peptic ulcer. There are more powerful medicines called proton pump inhibitors, which can completely stop acid production. Examples include omeprazole (eg Losec) and lansoprazole (eg Zoton). Any of these medicines will relieve your symptoms, and within a few weeks the ulcer will heal. However, once you stop taking the medicine, the ulcer may come back unless the H. pylori has been treated and removed. You can buy some of these medicines over the counter to treat indigestion. However, if you think you have an ulcer you should visit your GP for advice. Treating H. pylori infectionIf tests confirm that you have H. pylori, you will be prescribed medicines to treat it. This usually consists of a combination of three medicines: a proton pump inhibitor plus two antibiotics. Treating the H. pylori infection should allow the ulcers to heal and prevents them from coming back. Further information
Sources
Related topicsThis information was published by BUPA's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by BUPA doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional. Publication date: December 2007. Expected review date: December 2009.
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