Stomach ulcers, also known as gastric ulcers, are open ulcers that develop in the lining of the stomach.
Ulcers can also occur in a part of the intestine just beyond the stomach; These are known as duodenal ulcers.
Both stomach ulcers and duodenal ulcers are sometimes called peptic ulcers.
Stomach ulcers are usually caused by the bacteria Helicobacter pylori (H. pylori) or nonsteroidal anti-inflammatory drugs (NSAIDs).
These can break down the stomach’s defense against the acid it produces to digest food, allowing the lining of the stomach to become damaged and an ulcer to form.
However, it is believed that smoking increases the risk of developing stomach ulcers and can make the treatment less effective.
The most common symptom of a stomach ulcer is a burning or burning pain that develops in the abdomen (belly). However, some stomach ulcers are not painful and are only noticed when a complication of a stomach ulcer develops, such as bleeding from the ulcer .
The pain caused by a stomach ulcer can travel from the middle of the belly to the neck, to the navel or to the back. It can last from a few minutes to a few hours and often begins a few hours after eating. You can also wake up with pain during the night.
Taking antacids (medicines for indigestion) may temporarily relieve pain, but it will continue to reappear if the ulcer is not treated.
Less common symptoms of a stomach ulcer may include:
- Loss of appetite
- Feeling and being sick
Some people also find that they burp or swell after eating fatty foods.
When to seek medical advice:
Visit your family doctor if you experience persistent symptoms of a stomach ulcer.
Contact your GP immediately, or go to the nearest accident and emergency department if you have signs of a serious complication, including:
- Vomiting of blood: blood may appear bright red or have a dark brown, grainy appearance, similar to ground coffee.
- Dark, sticky, tar-like stools.
- A sudden and sharp pain in the belly that is constantly getting worse.
Your GP may suspect you have an ulcer, depending on your symptoms. They will want to know if you are taking nonsteroidal anti-inflammatory drugs (NSAIDs) and can be tested for Helicobacter pylori (H. pylori) infection.
You may be referred to the hospital for a procedure to look inside the stomach (a gastroscopy ).
Tests for H. pylori infection:
If your primary care provider thinks your symptoms may be caused by H. pylori infection, you may be recommended one of the following tests:
Breath test with urea:
You will be given a special beverage that contains a chemical substance broken down by H. pylori; Then your breathing is analyzed to see if you have an H. pylori infection or not.
Antigen test in the stool:
A small sample of stool is tested for the bacteria
A sample of your blood is tested for antibodies to H. pylori bacteria (antibodies are proteins produced naturally in the blood and help fight infection). This has been largely replaced by the stool antigen test.
If you get a positive test for H. pylori, you will need treatment to eliminate the infection, which can heal the ulcer and keep it from coming back. Read more about the treatment of stomach ulcers.
In some cases, you may be referred to a gastroscopy to look directly into your stomach and see if you have a stomach ulcer.
The procedure is carried out in the hospital and involves passing a thin flexible tube (an endoscope) with a camera at one end in the mouth and down into the stomach and the first section of the small intestine (duodenum).
A mild sedative injection may be given before the procedure and your throat will be sprayed with a local anesthetic to make it easier to pass the endoscope.
Images taken by the camera will usually confirm or rule out an ulcer. You can also take a small sample of tissue from your stomach or duodenum, so that you can analyze H. pylori bacteria.
Usually, a gastroscopy is performed as an outpatient procedure, which means you will not have to spend the night in the hospital.
If you have a stomach ulcer, your treatment will depend on what caused it. With treatment, most ulcers heal in one or two months.
If your stomach ulcer is caused by a bacterial infection with Helicobacter pylori (H. pylori), treatment with antibiotics and a medicine called proton pump inhibitor (PPI) is recommended.
This is also recommended if the stomach ulcer is thought to be caused by a combination of H. pylori infection and nonsteroidal anti-inflammatory drugs (NSAIDs).
If your stomach ulcer is caused simply by taking NSAIDs, a PPI medication cycle is recommended. Your NSAID use will also be reviewed, and you may be advised to take alternative pain relievers.
Sometimes an alternative type of medication, known as H2 receptor antagonists, is used instead of PPI, and sometimes additional medications called antacids can be given to relieve your symptoms in the short term.
You may have to repeat the gastroscopy after four to six weeks to verify that the ulcer has healed.
There are no special lifestyle measures you should take during treatment, but avoiding stress, alcohol, spicy foods and smoking can reduce your symptoms while your ulcer heals.
If you have H. pylori infection, you will usually be prescribed two or three antibiotics, which should be taken twice a day for a week.
Side effects of these antibiotics are usually mild and may include:
- Feeling sick.
- A metallic taste in your mouth.
You will be retested at least four weeks after the end of your antibiotic cycle to see if any H. pylori bacteria remain in your stomach. If there are, an additional course of eradication therapy can be administered using different antibiotics.
Proton pump inhibitors (PPI):
PPIs work by reducing the amount of acid produced by the stomach, preventing further damage to the ulcer as it heals naturally. Usually, they are prescribed for four to eight weeks.
- Diarrhea or constipation .
- Feeling sick.
- Abdominal pain (belly).
These should happen once the treatment is completed.
H2 receptor antagonists:
Like PPIs, H2 receptor antagonists work by reducing the amount of acid produced by the stomach.
Ranitidine is the H2 receptor antagonist most commonly used to treat stomach ulcers.
Side effects are rare, but may include:
Antacids and alginates:
All of the above treatments can take several hours before they begin to work, so your GP may recommend taking additional antacid medications to neutralize stomach acid and provide immediate, but short-term relief.
Some antacids also contain a medication called alginate, which produces a protective coating on the lining of the stomach.
These medications are available to buy without a prescription in pharmacies. Your pharmacist can advise you which one is best for you.
Antacids should be taken when you experience symptoms or when you wait for them, such as after meals or before bedtime. Antacids containing alginates are best taken after meals.
The side effects of both medications are usually minor and may include:
- Diarrhea or constipation
- Cramps in the stomach
- Feeling sick.
Review the use of NSAIDs:
If your stomach ulcer has been caused by taking NSAIDs, your primary care physician will want to review your use of them.
The use of an alternative analgesic not associated with stomach ulcers, such as paracetamol, may be recommended. Sometimes an alternative type of NSAID may be recommended that is less likely to cause stomach ulcers, called a COX-2 inhibitor.
If you are taking a low dose of aspirin (an NSAID) to reduce the risk of blood clots, your doctor will tell you if you should continue taking it.
If you need to continue taking it, you can prescribe a long-term treatment with an PPI or antagonist of the H 2 receptors along with aspirin, to try to prevent more ulcers.
It is important to understand the potential risks associated with the continued use of NSAIDs. You are more likely to develop another stomach ulcer and may experience a serious complication, such as internal bleeding.