Why do stomach ulcers happen? The causes, symptoms, and treatment of peptic ulcers

Written by: Dr Michael Mendall
Published:
Edited by: Emily Lawrenson

Stomach, or peptic ulcers are estimated to affect between 5 and 10% of the population at some point in their lives, statistically affecting more men than women. But why exactly do they happen, and can they be prevented? In this article, we asked expert gastroenterologist Dr Michael Mendall all about the causes of stomach ulcers, the signs and symptoms to watch out for, and when the right time is to visit a doctor. 

What causes a stomach (peptic) ulcer?

Stomach or peptic ulcers are caused by two common and one less common cause.

The most common cause of a stomach ulcer is infection with Helicobacter pylori, which in particular occurs in men who smoke. This infection is mainly caught in childhood and is especially common in people born in the developing world.

The other common type of ulcer occurs due to using non-steroidal anti-inflammatory drugs, particularly as you get older. These are common painkillers such as aspirin and Neurofen, which can be bought over the counter.

The final type of ulcer occurs as a result of cancer. Cancers start as ulcers and are more common in people with a past history of a stomach ulcer. However, the great majority of people who have stomach ulcers do not go on to develop cancer.

Are there different types of stomach (peptic) ulcers?

There are two types of stomach ulcers:

  • Gastric ulcers, which occur in the stomach and tend to occur in older people
  • Duodenal ulcers, which occur in the duodenum, the part of the intestine that leads away from the stomach

What symptoms would I have with a stomach ulcer?

The typical symptoms associated with a stomach ulcer are a burning pain in the epigastric region and sometimes also behind the breast bone. The pain is usually related to food and typically pain from a duodenal ulcer is worse when hungry, and relieved by eating, whereas with a gastric ulcer the pain is typically (but not always) worse with food. Vomiting and weight loss may occur. The symptoms will typically last for a few weeks and then go away for a few weeks before returning.

Ulcers due to non-steroidal anti-inflammatory drugs may be painless and only discovered if an examination is made for other reasons.

The most serious symptom of ulcers is bleeding from the stomach, which can present either as passing black bowel motion or as vomiting blood. The actor Kenneth Williams famously died from a bleeding ulcer.

Another serious complication of ulcers is perforation (where a small hole occurs). The pain may suddenly become much worse and the person will become seriously unwell. The celebrity Tara Palmer Tomkinson famously died from a perforated ulcer.

Seek medical advice urgently if you experience any of the following symptoms:

  • Vomiting blood
  • A sharp pain in your abdominal area which comes on suddenly, and gets gradually worse over time
  • Sticky, dark, tar-like stools

Are there diet restrictions for those with stomach ulcers?

There are no dietary restrictions for those experiencing a stomach ulcer. Modern treatments are very effective - in particular treatment for Helicobacter pylori, if present. It is important that Helicobacter infection, if present, is treated properly as there is growing resistance to the first line of antibiotics.

How do stress and lifestyle habits influence the risk?

The most important lifestyle risk factor for ulcers is smoking and excessive alcohol consumption. It has been suggested that stress can cause ulcers, and make them more difficult to heal.

Stomach ulcers can affect anyone at any age, but they are much more common in men, and tend to affect those who are above the age of 60 and people born in the developing world who move to the UK.

If you believe you have a stomach ulcer, pay a visit to your doctor and be sure to attend regular check-ups.

By Dr Michael Mendall
Gastroenterology

Dr Michael Mendall is a renowned London-based gastroenterologist who qualified from Cambridge University. He has made a number of important contributions to his field of expertise. He is internationally recognised with nearly 100 peer reviewed publications. He was the first to show that Helicobacter pylori infection of the stomach is mainly caught in childhood, and, more recently, was the first to show that obesity can be a cause of Crohn's disease. He specialises in endoscopy, inflammatory bowel disease, dyspepsia (indigestion) and IBS, among others, and has written extensively on the role of diet in Crohn's, about IBS, the treatment of dyspepsia and reflux and Helicobacter pylori infection. He is currently lead for gastroenterology at Croydon University Hospital, as well as a senior lecturer at St George's Medical School and a member of various medical organisations. He was named one of the top UK Consultants in the Tatler Guide 2013.

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