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Peptic ulcers

Published by Bupa's health information team, 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.

• Animation - How a peptic ulcer develops
• About peptic ulcers
• Symptoms
• Complications
• Causes
• Diagnosis
• Treatment
• Further information
• Questions and answers
• Related topics
• Sources

How a peptic ulcer develops

About peptic ulcers

The 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.

The different parts of the digestive system

Symptoms

Some 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:

• belching
• heartburn
• general discomfort in the abdomen
• bloating or fullness after eating
• feeling sick
• vomiting

You should see your doctor if you have:

• difficulty swallowing
• lost weight without trying to
• a reduced appetite
• seen blood in your vomit or bowel movements

These symptoms may be caused by problems other than peptic ulcers. You should visit your GP for advice.

Complications

Most people who have a peptic ulcer don't have any complications. However, possible complications include the following.

Bleeding

Occasionally 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:

• vomiting blood (usually bright red)
• vomit containing dark brown bits of clotted blood (with an appearance like ground coffee)
• blood in the faeces (usually dark red)
• black, tarry faeces

If you have any of these symptoms, you should see a doctor immediately.

Anaemia

If 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.

Perforation

Rarely, 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.

Causes

The following are the most important causes of peptic ulcers.

• The most common cause is infection of the stomach with bacteria called Helicobacter pylori or H. pylori. This infection is quite common; about half of the world's population is infected. These bacteria cause the stomach to make too much acid, which damages the lining of the stomach or duodenum and can cause the ulcer.
• Some medicines, called non-steroidal anti-inflammatory drugs (NSAIDs), can cause peptic ulcers. Examples of these medicines include aspirin, ibuprofen, naproxen and diclofenac. However most people can take these safely. If you are in doubt which painkillers to take, ask your pharmacist.
• Smoking and drinking excessive alcohol increase your chances of developing a peptic ulcer.

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.

Diagnosis

If 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 test

As 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.

Endoscopy

If 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 meal

This 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.

Treatment

Self-help

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

• not having food and drink that seems to cause more severe symptoms - these foods can include spicy foods, coffee and alcohol
• stopping smoking
• not taking painkillers that are likely to cause ulcers in the future - your GP or pharmacist can give you advice on other medicines you could take instead

Medicines

There 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 infection

If 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

• CORE (working name of the Digestive Disorders Foundation
  020 7486 0341 (not a helpline)
  www.corecharity.org.uk

		Peptic ulcer Q&As See our answers to common questions about peptic ulcer, including: Which foods worsen the symptoms of peptic ulcers? Where does Helicobacter pylori (H. pylori) come from? How long will it take before peptic ulcers improve?

Related topics

• Indigestion
• Indigestion medicines
• Iron-deficiency anaemia
• Physical activity
• Stopping smoking

Sources

• Longmore M, Wilkinson IB, Rajagopalan S. Oxford Handbook of Clinical Medicine. Oxford: Oxford University Press, 2004: 214
• Simon C, Everitt H, Kendrick T. Oxford Handbook of General Practice. 2nd ed. Oxford: Oxford University Press, 2006: 438-439
• Management of dyspepsia in adults in primary care. National Institute of Health and Clinical Excellence (NICE). 2004. Clinical Guideline 17, 2004
  www.nice.org.uk
  
• Peptic ulcers. CORE Charity
  www.corecharity.org.uk
  accessed 10 August 2007
• British National Formulary (BNF). Gastro-intestinal system. BMJ Publishing Group, 2007, 53: 37-69

This 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.

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