A peptic ulcer is a break or sore in the lining of the stomach or the first part of the small intestine (duodenum). Gastric ulcers occur on the inside of the stomach. Many people with a peptic ulcer will not exhibit symptoms and they are discovered incidentally during an endoscopy examination of the stomach. Expert gastroenterologist Dr David Neal explains the signs of a peptic ulcer and how it is treated…
What are the symptoms of a peptic ulcer?
Pain is the most common symptom caused by a peptic ulcer. Pain is usually in the upper abdomen but can be felt through to the back. It can also cause the following symptoms:
- Nausea and vomiting
- Altered appetite and weight loss
- Vomiting fresh blood – caused by bleeding ulcers
- Dark blood in stool – from bleeding ulcers
- Inflammation of surrounding tissues – which blocks food from passing into the small bowel
What causes a peptic ulcer?
Peptic ulcers are caused when acid in the upper gut erodes the inner lining of the stomach or duodenum leading to ulceration. If the ulcer erodes into a blood vessel they can cause bleeding, which can vary from minor bleeding that, in time, can lead to anaemia through to a major haemorrhage that’s a life-threatening emergency.
There are two main causes of peptic ulcers, a bacteria called Helicobacter Pylori (H.Pylori) and certain common painkilling medications.
- Helicobacter Pylori - This bacterium lives in the mucous layer that lines the stomach and protects the stomach from acid. Sometimes the bacteria causes inflammation of the stomach lining, which leads to the development of a peptic ulcer.
- Drugs - Aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) such as Ibuprofen and Nurofen can cause inflammation and sometimes ulceration of the stomach or duodenum. This is more likely to occur with regular use of these drugs especially if they are not taken with medication to reduce acid production. Other drugs that can increase the risk of peptic ulceration include steroids and certain antidepressants; anticoagulants can also increase the risk of bleeding. Peptic ulcers are more likely to occur in older people and in those who smoke and who consume alcohol.
How do you treat a peptic ulcer?
A peptic ulcer is diagnosed with an endoscopy examination whereby a fibreoptic camera is passed down through the mouth into the oesophagus, stomach and duodenum. Sometimes biopsy specimens are taken from the ulcer and to check if Helicobacter Pylori infection is present.
- Drugs to kill H. Pylori - If infection with H. Pylori is confirmed this requires treatment with a course of antibiotics. There are different combinations of antibiotics but most involve 2 different antibiotics and a drug to reduce acid production called a proton pump inhibitor (PPI). These are taken for 2 weeks. Sometimes a further course of treatment is required to get rid of the infection.
- Drugs to reduce acid production - Most people with a peptic ulcer will be prescribed medication to reduce acid production and to allow healing of the ulcer. The most common drugs are proton pump inhibitors and these include omeprazole, lansoprazole, pantoprazole and rabeprazole.
Not everyone can tolerate a PPI because of side effects. Ranitidine is another type of anti-acid medication which can also be used to treat ulcers although it is not as effective as a PPI.
The duration of treatment varies and needs to be individualised depending on ongoing risk factors for ulcers such as a requirement for aspirin and age. Usually, a minimum of 8 weeks treatment is required but some people will be recommended long-term treatment with acid lowering medication. Antacids may be prescribed to help with symptoms of an ulcer.
If you are diagnosed with a gastric ulcer you will have a repeat endoscopy after 6 – 8 weeks to check that the ulcer is healing. If you were diagnosed with H.Pylori infection this should be retested once you have completed the antibiotics to see if the infection has gone. This can be done via a stool test or an endoscopy.
Lifestyle measures to help treat a peptic ulcer
Treating a peptic ulcer should include an assessment of risk factors for the ulcer. If someone is on regular aspirin or NSAIDs the need for continued treatment with these drugs should be reviewed. Your doctor may recommend reducing the dose or stopping these drugs.
Stopping smoking and reducing alcohol will be relevant for some. As is a change in diet, eating plenty of vitamin-rich foods such as fruit and vegetables and fat-free or low-fat dairy foods. Eating foods containing whole grains with lean meats also helps. It is recommended to cut back on caffeine, alcohol, spicy foods and highly fatty meats such as sausage, salami and bacon.
Stress can make the symptoms of an ulcer worse. Measures to reduce stress should be undertaken.