Peptic Ulcers

What is a peptic ulcer?

An ulcer is damage to the inner lining (the mucosa) of the stomach or the upper part of the intestine (duodenum). Stomach ulcers can affect people of any age, but they become more common as people age,  affecting men and women equally. The size of peptic ulcers can vary from millimetres (mm) to several centimetres (cm) across.

Why do people get ulcers?

The most common cause is infection with Helicobacter pylori bacteria, and this is responsible for up to 90% of all cases of peptic ulceration.

The second most common cause is damage due to  non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin used regularly by many people for arthritis, rheumatism, backache, headaches and period pain.

Ulcers can also occur in people weakened by severe disease (such as chronic respiratory disease or major trauma) and in inflammatory conditions affecting any part of the gut.

What does an ulcer feel like?

This varies greatly from person to person. Many people never realise that they have an ulcer. Others feel pain or a burning sensation in their upper abdomen. The symptoms are often described as indigestion, heartburn, hunger pangs or dyspepsia. Some sufferers find that eating actually helps settle their discomfort for a while, but others find it makes the discomfort worse, particularly citrus drinks, spicy and smoked foods.

What are the warning signs of a peptic ulcer?

  • Difficulty swallowing, or regurgitation (bringing up food after starting to eat)
  • Persistent nausea and vomiting
  • Vomiting blood or vomit with the appearance of coffee grounds
  • Black or tar-like stools
  • Weight loss
  • Anaemia (paleness and fatigue)
  • Sudden, severe and incapacitating abdominal pains.

How does the doctor make a diagnosis?

The diagnosis can only be definitely confirmed or excluded by a gastroscopy. A gastroscopy (or upper GI endoscopy) involves inserting a small fibre-optic camera down the throat to view the lining of your gullet (oesophagus), stomach and duodenum. The gastroscopy is more helpful in diagnosis if it is performed before you take any acid-reducing medication.

An X-ray examination, involving a barium (a natural element visible on an X-ray) meal, can also be used, but it is not quite as reliable or helpful as a gastroscopy. It does not offer any opportunity to take tissue samples (biopsies) for microscopic diagnosis of tissue abnormalities and infection.

What is Helicobacter pylori?

Helicobacter pylori is a tiny bacteria living inside and under the lining of the stomach. The groups most often affected by this bacteria are elderly people and people in developing countries. People carrying the bacteria today have most probably been infected during childhood. The risk of acquiring infection for an adult is modest - less than 1%  every year. Helicobacter pylori in itself does not usually cause any ulcer symptoms. Nevertheless, this bacteria is the most common cause of ulcers in the stomach and the duodenum. Fortunately, Helicobacter pylori infection can be eliminated by taking a combination of antibiotics and an antacid treatment called a proton pump inhibitor (PPI). If the bacteria is not eliminated, most people get a recurrence of their ulcer after a short period of time.

Complications of peptic ulcers

Possible complications of a peptic ulcer include;

Bleeding. Occasionally ulcers can cause the lining of your stomach or small bowel to bleed. If this happens suddenly, you may vomit blood, which may be bright red or look like coffee grains (dark brown bits of clotted blood). You might also have dark faeces that look like tar and have a strong odour.

Anaemia. If the bleeding from the ulcer is slow, you may develop anaemia – where you have too few red blood cells or not enough haemoglobin in your blood, causing fatigue and paleness.

Perforation. Rarely, the ulcer may develop deep in your stomach wall or small bowel and make a hole in your abdomen. This is called perforation – it causes severe pain and you will need emergency surgery.

Pyloric stenosis. This can result if you have a peptic ulcer that causes long-term inflammation in the lining of your stomach or small bowel. It causes the small passage called the pylorus, which links your stomach and the first part of your small bowel, to narrow. The main symptom of pyloric stenosis is vomiting.

What can I do to help myself?

Always stop smoking – this is a major risk factor for developing peptic ulcers. Moderate your alcohol intake too.  If for any reason you have an increased risk of ulcers, it is important to seek advice before considering NSAIDs or aspirin.

If you have a history of indigestion or stomach trouble, only take aspirin and NSAIDs after discussion with your doctor or pharmacist. If you have previously had bleeding from a peptic ulcer, you should avoid aspirin and NSAIDs completely.