Gastric Ulceration

What is gastric ulceration?

Gastric ulceration, also called a gastric ulcer or stomach ulcer, is an open sore that forms in the lining of your stomach. It happens when stomach acid wears away the layer that normally protects your stomach wall.

What are the symptoms of gastric ulceration?

The main symptom is pain in your upper tummy, often described as burning or gnawing. Not every gastric ulcer causes pain, some are only picked up after a complication such as bleeding.

• Burning or gnawing pain in your upper tummy, between your breastbone and belly button
• Pain that's often worse at night or within about 30 minutes of eating
• Indigestion and heartburn (a burning feeling in your chest)
• Bloating, burping, and feeling sick or being sick
• Antacids may ease the pain for a while, but it will keep coming back until the ulcer is treated.

What are the causes of gastric ulceration and who is at risk?

Two things cause most gastric ulcers: an infection called Helicobacter pylori (H pylori), and regularly taking anti-inflammatory painkillers (NSAIDs), such as ibuprofen.

H pylori is a common infection, affecting up to half of people worldwide, and it's possible to have it without knowing. It damages your stomach's defences against acid, allowing an ulcer to form. NSAIDs work in a similar way: they irritate your stomach lining directly and stop it repairing itself properly.

Your risk is higher if you smoke, if you're older, previous peptic ulcer disease and if you are taking anticoagulants, steroids or antiplatelet therapy concurrently. Stress and diet don't cause gastric ulcers, though spicy or acidic food, alcohol and smoking can make symptoms worse once you have one.

Less often, a gastric ulcer is caused by other infections, by a rare condition that makes your stomach produce too much acid (Zollinger-Ellison syndrome), or by severe physical stress on your body, such as recovering from a serious illness or injury.

Are there different types of gastric ulceration?

Gastric ulcers form in your stomach. If a similar sore forms just beyond your stomach, in the first part of your small intestine, it's called a duodenal ulcer instead, and both are grouped together as peptic ulcers.

The two can feel different. Gastric ulcer pain often gets worse within about 30 minutes of eating, while duodenal ulcer pain tends to ease with food and then return 2–4 hours later.

How is gastric ulceration diagnosed?

Your GP will start by asking about your symptoms and medical history, including whether you take NSAIDs regularly. They may weigh you and feel your tummy, and might arrange tests for H pylori, such as a breath test, a stool sample test or a blood test.

You may also be referred for a gastroscopy (sometimes called an endoscopy), where a thin, flexible tube with a small camera is passed through your mouth and down into your stomach. This is done as an outpatient, so you won't need to stay overnight, and a small tissue sample can be taken at the same time to test for H pylori.

You might be offered a repeat gastroscopy 4–6 weeks later to check the ulcer has healed.

How is gastric ulceration treated?

Treatment depends on what's causing your gastric ulcer, and it usually lasts from 1 week up to 2 months.

Non-surgical options

If you test positive for H.pylori infection, eradication therapy consisting of a PPI plus two antibiotics are taken twice daily for 7 days. The antibiotic choice depends on penicillin allergy status and previous antibiotic exposure. After eradication therapy, the PPI treatment is continued typically for 4-8 weeks or longer and a repeat gastroscopy is usually arranged to confirm healing.

If you were treated for H pylori, you'll usually be retested at least 4 weeks after finishing your antibiotics to check the infection has cleared. If it hasn't, a further course with different antibiotics may be needed.

There are also things you can do yourself to ease symptoms and lower the chance of a gastric ulcer coming back:

• eat smaller meals, more often
• have your evening meal 3–4 hours before you go to bed
• try to keep to a healthy weight
• find ways to manage stress
• avoid food or drink that triggers your symptoms, such as fatty or spicy food, coffee and chocolate
• don't smoke, and keep alcohol within the recommended limits
• don't take NSAIDs without checking with a doctor first.

Surgical options

Surgery is rarely needed now that gastric ulcers can usually be treated with medicine. It's mainly used for complications: to stop bleeding that endoscopy can't control, to repair a hole in your stomach wall (a perforation), or to widen your stomach outlet if scarring has narrowed it.

Bleeding and small tears can often be treated during the same gastroscopy used to diagnose your ulcer, using tools passed down the tube, so you may not need a separate operation at all.

When should I see a doctor?

See a GP if you have indigestion that doesn't go away with treatment, or if your tummy pain keeps coming back.

Get an urgent GP appointment or call NHS 111 if you have symptoms of a gastric ulcer and:

• your tummy pain is getting worse or does not go away
• you've lost your appetite
• you feel full after a very small amount of food
• you've lost weight without trying to
• it feels like you have a lump in your tummy
• it's painful or difficult to swallow
• you keep being sick
• you feel tired all the time.

Call 999 or go to A&E immediately if:

• you're vomiting bright red blood, or your vomit looks like ground coffee
• your poo has blood in it, or is black, sticky and very smelly
• you have severe tummy pain, or it's painful to touch your tummy
• you have chest pain that started suddenly.

Don't drive yourself to A&E. Ask someone else to drive you, or call 999 for an ambulance, and take any medicines you're taking with you.