Stomach ulcer
A stomach ulcer is when a part of the lining of the inside of your stomach becomes damaged, causing something known as a gastric ulcer (also known as peptic ulcer). The most common cause is infection with Helicobacter pylori (H. pylori) bacteria, and this is responsible for up to 90% of all cases of peptic ulceration.
The second most common cause is damage due to aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) used by many people for arthritis, rheumatism, backache, headaches and period pain.
Ulcers can also occur in people weakened by severe disease (such as chronic respiratory disease or major trauma) and in inflammatory conditions affecting any part of the gut.
A stomach ulcer can cause people to experience pain in the upper central part of their abdomen, often described as a gnawing-type pain, along with other symptoms such as feeling nauseous and the sensation of heartburn. Most stomach ulcers are mild and heal well with treatment. If the stomach ulcer is severe and left untreated it can become serious, and even lead to life-threatening complications that require urgent medical attention. Symptoms of a severe ulcer include vomiting blood, passing black stools (known as melena), or excruciating abdominal pain.
What is Helicobacter pylori?
Helicobacter pylori is a tiny bacteria living inside and under the lining of the stomach. The groups most often affected are elderly people and people in developing countries. People carrying the bacteria today have most probably been infected during childhood. The risk of acquiring infection for an adult is modest - less than 1 per cent every year. Helicobacter pylori in itself does not usually cause any ulcer symptoms. Nevertheless, this bacteria is the most common cause of ulcers in the stomach and the duodenum. Fortunately, Helicobacter pylori infection can be eliminated by taking a combination of antibiotics and an antacid treatment called a proton pump inhibitor (PPI). If the bacteria is not eliminated, most people get a recurrence of their ulcer after a short period of time.
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What about the duodenum
Peptic ulcers can also occur in the first part of the bowel that begins after the stomach, known as the duodenum. These are called duodenal ulcers, and they are actually more common than stomach ulcers. In a very small number of cases, a peptic ulcer can progress over time to become cancer, this is not common but is usually linked to the H. pylori infection mentioned earlier.
Peptic ulcers are not contagious, but the H. pylori infection that can cause them can be. It is passed on through saliva and is very common, with over half of the population being infected with it. We should be clear, though, having H. pylori doesn't mean you are guaranteed to get any symptoms at all, never mind an ulcer. Large proportions of patients are well without any symptoms and therefore require no treatment.
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Stomach ulcers need treatment via medication from your doctor. However, there are lifestyle changes you can do alongside to help with your symptoms. Avoiding known triggers such as smoking, excessive alcohol, spicy foods, and caffeine will greatly help.
Medications known as proton pump inhibitors (PPIs) are the treatment of choice for stomach ulcers. They help reduce the amount of acid produced by the stomach. Our stomachs produce acid to help break down the food we eat. An imbalance and too much of a good thing can damage the stomach lining. By lowering the amount of acid in the stomach, the medication helps provide the best environment for the stomach lining and ulcer to heal.
If you are found to have H. pylori infection, you will also be given a course of antibiotics, alongside the PPI, in order to get rid of the H. pylori bacteria.
If it is severe, they may also give an antacid to help will heartburn symptoms.
What are the warning signs of a peptic ulcer?
- Difficulty swallowing or regurgitation
- Persistent nausea and vomiting
- Vomiting blood or vomit with the appearance of coffee grounds
- Black or tar-like stools
- Weight loss
- Anemia (paleness and fatigue)
- Sudden, severe and incapacitating abdominal pains
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When should I see my doctor?
You should see your doctor if you have any of the symptoms of a stomach ulcer or if you are still having symptoms after your course of treatment has finished. You should book an urgent visit with your doctor if you are having any symptoms of unexplained weight loss, night sweats, or swelling of your stomach.
If any signs of a severe ulcer, such as vomiting blood, severe stomach pain, or black stools (please note that if you are taking iron supplementation, black stools are a normal side effect of the medication), then urgent medical attention is needed. Depending on the severity, this can be via an urgent same-day visit with your doctor or by calling 911 in an emergency.
What will my doctor do?
The doctor will ask you about your symptoms, your medical history, what medications you are taking, and any relevant family medical history. If you are comfortable, they will then feel your abdomen and may do further general examinations, such as looking at your hands and eyes.
If an ulcer is suspected, you will likely have blood tests taken and a test for H. pylori. This is most commonly via a stool test, although there are other versions, such as a blood test or breath test (you breathe into tubes, and that is then tested). You may be referred to have a gastroscopy which is where a camera is used to look at your stomach. To rule out stomach cancer, an ulcer biopsy is usually taken while having a gastroscopy.
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