Stomach ulcer

What is a stomach ulcer?

A stomach ulcer, also called a gastric or peptic ulcer, is an open sore that develops in the lining of your stomach where stomach acid has worn it away. The same kind of sore can also form just beyond the stomach, in the first part of the small intestine, where it's known as a duodenal ulcer.

What are the symptoms of a stomach ulcer?

The main symptom is discomfort in your upper abdomen that feels like it's being eaten away by acid – sometimes sharp, sometimes more of a dull ache. It's frequently worse at night, may briefly ease after eating or taking an antacid, and tends to keep returning if the ulcer itself isn't treated.

Other symptoms can include:

• indigestion and heartburn
• bloating, burping or feeling unusually full, especially after fatty food
• nausea or vomiting.

Not everyone with a stomach ulcer feels it – some are 'silent' and only come to light once a complication, such as bleeding, develops.

What causes a stomach ulcer and who is at risk?

A stomach ulcer forms when the layer that normally protects your stomach lining from its own acid breaks down, letting the acid damage the tissue underneath. Two causes are responsible for the great majority of cases:

• Infection with Helicobacter pylori (H. pylori) bacteria: This is a very common infection, often causing no problems at all, that can sometimes irritate and weaken the stomach lining
• Taking NSAIDs: These are a family of anti-inflammatory painkillers that includes ibuprofen and aspirin. Taking them often or in high doses over time irritates the stomach lining directly and gets in the way of its own repair process.

Your chances of developing one rise with age, and smokers are affected more often too. There's little solid evidence that stress or particular foods actually cause ulcers in the first place, though they can make symptoms worse once you have one.

Rare causes include other infections; a condition called Zollinger-Ellison syndrome, which causes the stomach to produce excess acid; and severe physical stress from a serious illness or injury.

Are there different types of stomach ulcer?

Stomach ulcers are sometimes grouped together with a closely related condition under the umbrella term peptic ulcer, which simply describes where the sore has formed:

• A gastric (stomach) ulcer: This forms in the lining of the stomach itself
• A duodenal ulcer: This forms just beyond the stomach, in the first part of the small intestine.

The two share the same main causes and are diagnosed and treated in much the same way.

How is a stomach ulcer diagnosed?

Your doctor will ask about your symptoms and medical history, including whether you take NSAID painkillers often, and may weigh you and examine your abdomen.

You may be tested for H. pylori, using a breath test (where you swallow a special drink or tablet, then breathe into a tube), a stool sample or occasionally a blood test.

If a closer look is needed, the next step is usually a gastroscopy – a same-day outpatient procedure where a slim, flexible camera on a cable is guided in via your mouth to view your stomach lining from the inside. This lets your doctor see the ulcer directly, and a small tissue sample can be taken at the same time to test it for H. pylori. A repeat gastroscopy several weeks later is sometimes used to confirm the ulcer has healed.

How is a stomach ulcer treated?

Treatment depends on what's causing your ulcer, and most people recover well with medication rather than surgery.

Non-surgical treatment

• If H. pylori is found, a course of 2 or 3 antibiotics, typically taken over about a week, is given to clear the infection
• Medicines that reduce the amount of acid your stomach makes, such as proton pump inhibitors (including omeprazole, lansoprazole and pantoprazole) or, less often, H2 blockers (such as famotidine or cimetidine), usually taken for 4 to 8 weeks
• Medicines that coat and protect the ulcer while it heals, sometimes used alongside acid-reducing treatment, particularly for ulcers linked to NSAID use
• If an anti-inflammatory painkiller is the cause, switching to a different painkiller, such as paracetamol, or reducing the dose, under your doctor's guidance.

Alongside medication, it helps to:

• eat smaller meals
• leave 3 to 4 hours between your evening meal and bedtime
• cut back on things that irritate your stomach such as smoking, alcohol, and fatty or spicy foods
• find ways to manage stress, since these can all make symptoms worse even though they don't cause the ulcer on their own.

Most stomach ulcers heal within a few weeks to a couple of months, and you may be offered follow-up tests to confirm the ulcer and any infection have cleared. If symptoms return, let your doctor know, since switching medicine or extending the course can often be enough to sort it out.

Surgical and procedural treatment

Surgery isn't usually needed for a straightforward stomach ulcer, but a procedure may be required for certain complications:

• Bleeding: This can often be treated during the same gastroscopy used to diagnose the ulcer, by sealing the bleeding point or injecting medication directly into it – more significant blood loss may need a blood transfusion
• Perforation: A hole that's formed right through the stomach wall needs urgent surgical repair
• A blockage: If scar tissue from a long-standing ulcer narrows the passage where your stomach empties into the intestine and blocks food from getting through, this can sometimes be widened using a small balloon passed through the endoscope, or, occasionally, corrected with surgery.

When should I see a doctor?

• Routine: Book a routine GP appointment for indigestion that won't clear up despite treatment, or abdominal pain that repeatedly returns
• Urgent: Get an urgent GP appointment, or contact NHS 111, if your abdominal pain is worsening or persistent, your appetite has dropped off or you're losing weight without trying, small amounts of food leave you feeling overly full, swallowing has become painful or difficult, there's a sensation of a lump in your abdominal, vomiting won't stop, or you feel exhausted all the time
• Emergency: Treat it as an emergency, calling 999 or heading straight to A&E, if you vomit blood, whether bright red or resembling coffee grounds, if your stools turn black, sticky and unusually foul-smelling, or if your tummy pain becomes severe, especially if it hurts to touch.

Get someone else to drive you to hospital rather than driving yourself, or dial 999 for an ambulance if that's not possible.