Stomach ulcer

Normally, the lining of your stomach is coated with a protective mucus. However, if this mucus is damaged, the digestive acids in your stomach can attack the lining and an ulcer can develop.

The general term ‘peptic ulcer’ describes ulcers that are caused by acid in the stomach. This includes stomach ulcers and duodenal ulcers that develop in the first part of the small intestine known as the duodenum. Stomach ulcers are less common out of the two.

It’s estimated that one in 10 people will develop a stomach ulcer at some point, with men being more susceptible. A stomach ulcer can occur at any age but your risk is higher if you’re over 60.

Some stomach ulcers are painless and trigger few, if any, symptoms. However, others cause stomach pain and indigestion. In rare cases, complications may develop which can be serious.

Most stomach ulcers can be cured with medical treatment – often within two months of diagnosis.

Burning abdominal pain is the most common stomach ulcer symptom. This can last from a few minutes to several hours, but you may also have other signs of a stomach ulcer. These include:

• Indigestion
• Heartburn
• Feeling sick (nausea)
• Intolerance of fatty foods
• Loss of appetite and/or weight loss
• Pain in your upper abdomen a couple of hours after eating
• Burping
• Pain in the neck or the back

Occasionally, potentially life-threatening stomach ulcer complications can develop, including bleeding, perforation of the stomach lining and gastric obstruction. Get immediate medical advice if you’re:

• Vomiting severely and frequently
• Vomiting blood – this may be red or coffee-coloured depending on the severity of bleeding
• Passing dark, sticky stools – caused by blood in the bowel
• Suffering from acute, severe stomach pain that’s becoming increasingly painful

In some cases, stomach ulcers aren’t painful and may go unnoticed until one of these complications develop.

There are a number of other conditions that also cause similar symptoms to a stomach ulcer, so it's important to go to your GP for a diagnosis. Although some of these are rare, conditions that also cause stomach pains include:

• Abdominal aortic aneurysm
• Acute ulcers
• Chronic pancreatitis
• Coronary heart disease
• Irritable bowel syndrome
• Drug-induced dyspepsia
• Crohn's disease
• Gastro-oesophageal reflux disease (GORD)
• Gastric cancer
• Hepatitis
• Gallstones
• Diverticular disease
• Zollinger-Ellison syndrome

If you regularly have stomach ulcer symptoms, make an appointment with your GP, who may refer you to a consultant. If your GP or consultant suspects you have a stomach ulcer, they’ll arrange a range of tests, which may include:

• A blood test to check for anaemia and that your liver and pancreas are healthy
• A stool sample, biopsy, blood or breath test to check for H. Pylori – an infection which can cause stomach ulcers
• A gastroscopy – when a tiny camera films the inside of your digestive system, identifying problems such as stomach ulcers. This is usually done as an outpatient case and you may be given a sedative beforehand
• A biopsy to check for stomach cancer, which can have a similar appearance to a stomach ulcer

You’ll need to have a gastroscopy if you have:

• Iron-deficiency anaemia
• Chronic blood loss
• Weight loss
• Persistent vomiting
• Difficulties in swallowing, known as progressive dysphagia
• Swelling or changes to the shape of your abdomen due to an epigastric mass

If you’re over the age of 55, your doctor may recommend a gastroscopy if you have:

• Had a stomach ulcer or gastric surgery previously
• Used NSAIDs
• A condition called pernicious anaemia
• A family history of gastric carcinoma

There are two main reasons for the stomach lining’s protective mucus being damaged, allowing stomach ulcers to form. These are:

• H. pylori infection – where the bacteria irritates the stomach lining making it vulnerable to acidic damage. It's thought that this accounts for around 80% of stomach ulcer cases but doesn’t always cause symptoms
• Long-term use of non-steroidal anti-inflammatory drugs (NSAIDs), including aspirin, ibuprofen. naproxen and diclofenac

In rare cases, viral infections and conditions such as Crohn’s disease can trigger stomach ulcers.

Over-the-counter antacid medication will provide instant, short-term relief from many symptoms, including stomach ulcer pain. A usual course of antacid medication is four to eight weeks. Lifestyle changes can also help. Try:

• Reducing stress
• Avoiding alcohol, coffee and symptom-triggering foods such as fatty or spicy foods, tomatoes and chocolate
• Losing any excess weight
• Stopping smoking
• Eating smaller meals and avoiding eating late at night

Treating the cause of your stomach ulcer is the best course of action, but which treatment you’ll receive will depend on the cause of your ulcer.

If you’re diagnosed with an H. Pylori infection, your doctor will prescribe antibiotics and acid-suppressing medication to help your stomach ulcer heal and clear the infection. If you don’t complete the full course of your medication, your ulcer is likely to return.

If you take NSAIDs, your doctor may review your medication and prescribe alternative pain relief, such as paracetamol, to allow your stomach ulcer to heal. If you need to take NSAIDs for other conditions, your doctor may suggest taking acid-suppressing medication indefinitely.

In some cases, your doctor may prescribe acid-suppressing medication for short term use. Proton pump inhibitors (PPIs) prevent further damage to the stomach ulcer and help it heal naturally as they reduce the amount of acid your stomach produces. PPIs are often prescribed for four to eight weeks. Antacids neutralise your stomach acid and provide immediate short-term relief. Some antacid medication contains alginate which further protects the lining of your stomach.

Surgery is only usually recommended for more severe cases where complications occur, such as stomach perforation.

After treatment, you may have another gastroscopy to see how well your ulcer has healed.

What does stomach ulcer pain feel like?

The most common symptom of a stomach ulcer is a burning pain in the abdomen, which can last for several hours. You may also feel pain in your neck or back, or not have any pain at all.

What causes stomach ulcers?

A stomach ulcer is caused when the digestive acids attack the stomach wall after the protective mucus lining has been damaged.

There are two main reasons for the stomach lining’s protective mucus being damaged. The most common cause is a bacterial infection (H. pylori) and the other is long-term use of non-steroidal anti-inflammatory drugs (NSAIDs). In rare cases, viral infections and conditions such as Crohn’s disease can trigger stomach ulcers.

What happens if I don’t receive treatment?

If left untreated, there’s a risk that your stomach ulcer can cause serious complications which may be fatal. These include internal bleeding, infection in your abdominal cavity and obstruction of the digestive tract.

What foods are good for ulcers?

A healthy diet of fruits (particularly those high in vitamins A and C), vegetables and whole grains may relieve stomach ulcer pain. It can also help to eat foods containing probiotics, such as yoghurt or miso.

What should you not eat and drink with an ulcer?

You may find that spicy foods and alcohol worsen your stomach ulcer symptoms. Drinking milk can also cause excess acid in the stomach which will increase pain.