Stomach ulcer: Symptoms and treatments

A stomach ulcer – also known as a gastric ulcer – is an open sore that develops on the lining of your stomach. It’s also often referred to as a peptic ulcer – the word peptic signals that the problem is caused by stomach acid. However, peptic ulcers also include duodenal ulcers, which are the same as stomach ulcers but located in your duodenum, the first part of your intestine or small bowel (where food passes from your stomach). Peptic ulcer disease is another term often used to collectively describe gastric and duodenal ulcers.
 
The symptoms for stomach and duodenal ulcers are the same, as are the treatments. There are, however, other types of peptic ulcer, including oesophageal ulcers – these are  found in the lining of the oesophagus, the tube that carries food from your mouth down your throat and into your stomach.
 
Stomach ulcers usually measure more than 5mm in diameter. Experts claim they’re less common than duodenal ulcers (i), though it’s difficult to tell exactly how many people in this country have either type (US experts estimate between one and six per cent of the population in the States have peptic ulcers (ii)).
 
However, we do know that men are more susceptible to developing peptic ulcers than women: in the past, 10 times more men had duodenal ulcers than women, while there were three men with stomach ulcers for every two women (iii). Research also suggests that people who smoke have twice the risk of developing a stomach ulcer than those who don’t smoke (iv).
 
Thankfully stomach ulcers are much less common now than they used to be, largely because we have much better treatments for them (in 1979, 22 per cent of people developed duodenal ulcers, while in 1997 just under six per cent were affected (v)). And while men may still be slightly more at risk, the incidence difference between the sexes is considered more even these days too. Meanwhile, peptic ulcers can affect anyone of any age – though you’re more likely to develop a stomach ulcer in your 50s, 60s and 70s and a duodenal ulcer in your 30s, 40s and 50s (v).
 

What are the symptoms of a stomach ulcer?

 
The main symptom of a stomach ulcer is pain or discomfort, usually in the upper abdomen – the area between your navel and breastbone. It may be a dull, burning or gnawing pain, though some people with a stomach ulcer don’t experience pain, and they may not even realise they have a problem until they develop a complication such as bleeding (see below for more information on stomach ulcer complications).
 
Some people with stomach ulcers can have pain that lasts a few minutes at a time, while others may suffer for hours. Eating may make the pain feel better, or it could make it feel worse. If you have a stomach ulcer you could also wake up in the middle of the night with stomach pain (or you may have pain at other times when your stomach is empty). Taking indigestion medicines called antacids can often ease the pain. However, the effect is temporary, and if you don’t get your ulcer treated the pain will keep coming back.
 
There are also other, less common, symptoms of a stomach ulcer, including:
 

• Bloating

• Indigestion

• Feeling uncomfortably full after eating (including when you haven’t eaten very much)

• Heartburn

• Poor appetite

• Nausea and vomiting

• Retching (feeling as if you’re going to be sick but not actually vomiting)

• Unintentional weight loss

 

What are the complications of a stomach ulcer?

 
According to the NHS, stomach ulcer complications are relatively uncommon – but when they do happen, they can be very serious (vi). There are three main complications:
 
1. Internal bleeding
 
The most common complication of a stomach ulcer, internal bleeding can happen if an ulcer develops where there is a blood vessel in the stomach lining. This is a serious complication and can be particularly risky for older people and people with multiple medical conditions. It’s also more common in those taking blood-thinning medication such as aspirin and warfarin.
 
The bleeding itself can be rapid and severe or slow and long term. Symptoms of rapid and severe internal bleeding include:
 

• Passing black, sticky and tar-like stools (melaena)

• Feeling lightheaded or fainting

• Vomiting blood (haematemesis)

 
Less sudden bleeding can also make you vomit blood, though it looks dark brown – a bit like coffee grounds – rather than bright red, because the blood has been partially broken down by your stomach acid. If you have any of these symptoms, contact your GP or ring NHS 111 immediately.
 
Meanwhile, slow, long-term bleeding typically causes anaemia, which causes symptoms including the following:
 

• Shortness of breath

• Fatigue

• Heart palpitations

• Pale skin

 
You can read more about the symptoms of anaemia in our guide to anaemia and iron deficiency. See your GP if you have the symptoms of anaemia even if you haven’t been diagnosed with a stomach ulcer, as having untreated anaemia may affect your immune system and make you more susceptible to infections.
 
2. Stomach perforation
 
This is when a stomach ulcer causes a perforation – or split – in the lining of your stomach. It’s not as common as internal bleeding, but it can be very serious and lead to a condition called peritonitis. An infection of the lining of your abdomen – the peritoneum – peritonitis can spread quickly into your blood and cause sepsis, then spread to other organs where it can cause organ failure.
 
Peritonitis is a serious medical emergency, its most common symptom being sudden abdominal pain that gets steadily worse (contact your GP or call NHS 111 if you have this type of pain as you will need hospital treatment if it is peritonitis).
 
3. Gastric outlet obstruction
 
A swollen or scarred stomach ulcer, if it’s in a certain position, can stop food passing through your digestive system normally – a condition called gastric outlet obstruction. This happens very rarely these days, but when it does develop it can cause frequent and severe vomiting, often with large amounts of undigested food.
 
Other symptoms of gastric outlet obstruction include feeling constantly full or bloated, feeling uncomfortably full after not eating much food and losing weight without trying. If you’re affected by gastric outlet obstruction, you may also experience the symptoms of constipation and a loss of bowel movements.
 
Another possible complication of a stomach ulcer, meanwhile, is when the ulcer penetrates through the stomach and into another nearby organ.
 

What causes peptic ulcers?

 
 Peptic ulcers develop on the lining of your stomach or digestive tract – called the mucosa – when acid from your stomach damages the mucosa and causes inflammation. This typically happens when the mucosa becomes weakened or when your stomach produces an increased amount of acid (in normal amounts stomach acid is important as it helps you break down and digest food while also killing germs). 
 
Two main things cause this damage – an infection caused by bacteria called Helicobacter pylori (H. pylori), and taking medicines that irritate your mucosa including anti-inflammatory medicines called non-steroidal anti-inflammatory drugs (NSAIDs).
 

H. pylori infection

 
According to Patient UK, H. pylori infections cause around 80 per cent of stomach ulcers and 95 per cent of duodenal ulcers (iii). These bacteria are commonly found in the stomach, and many people who have them don’t develop any symptoms. Others, however, can develop stomach ulcers as well as a common type of stomach problem called gastritis.  In both cases, symptoms are caused by the bacteria causing inflammation and damaging the stomach lining.
 
H. pylori is thought to be spread from person to person, though we don’t know exactly how this happens (vii).
 

Anti-inflammatory medicines

 
NSAIDs such as ibuprofen, aspirin and naproxen are thought to be more likely to cause a stomach ulcer if you’re older and/or you take them at high doses for a long time – though many people take them without having any problems. These medicines are thought to cause ulcers because they stop the stomach and duodenum’s natural ability to protect themselves against stomach acid (viii). NSAIDs may also interfere with blood clotting, which is problematic if a stomach ulcer bleeds.
 
Meanwhile, other things that may increase your risk of developing a stomach ulcer include:
 

• Having a family history of stomach ulcers

• Smoking

• Drinking too much alcohol

• Your age (getting older increases your risk)

• Other medicines including bisphosphonates (drugs that treat osteoporosis), some types of anti-depressants and steroid medication (your risk is even greater if you take these alongside NSAIDs)

• Other infections (that is, not caused by H. pylori)

• Some conditions that affect the stomach such as Crohn’s disease

• Recreational drugs such as crack cocaine

• Surgery or medical procedures that affect the stomach

• Staying in hospital intensive care

• A rare disease called Zollinger-Ellison syndrome (this causes the development of tumours in the duodenum or pancreas that can make your stomach produce too much acid)

 
Occasionally there may be no obvious cause of a stomach ulcer – in this case it’s called an idiopathic peptic ulcer. And while in the past it was thought that some other things such as stress, anxiety, spicy and rich foods caused stomach ulcers, these days we know this isn’t true – though some foods may well aggravate an ulcer that has already developed (read on to find out more about foods you may want to avoid).
 

How are peptic ulcers treated?

 
If your doctor thinks you may have a stomach ulcer and you don’t take anti-inflammatory medicines frequently, they may recommend one or more tests to check for the presence of an H. pylori infection.
 
You may also be referred to hospital for a gastroscopy, which is the only way to confirm you have a stomach ulcer, whatever the cause. This is a test that looks inside your stomach and duodenum via an endoscope, which is a thin, flexible tube that carries a tiny camera. The tube travels down your throat into your stomach and duodenum, so you may need a mild sedative before the procedure to make things more comfortable. Gastroscopies are usually carried out in a day, so you won’t have to stay in hospital overnight.
 
If your gastroscopy confirms you have a peptic ulcer, you may be offered one or more medicines to help it to heal quickly:
 

• Antibiotics and medicines that reduce stomach acid called proton pump inhibitors (PPIs) are recommended to those who have a stomach ulcer as a result of having an H. pylori infection (or indeed if your stomach ulcer has been caused by an infection as well as taking NSAIDs)

• PPIs are prescribed for peptic ulcers caused by just taking NSAIDs

 
If you have to take antibiotics you’ll usually be prescribed two different types, both of which you’ll take for a week. PPIs, on the other hand, are prescribed for a longer period, usually for four to eight weeks.
 
Other medicines used to treat peptic ulcers include H2-receptor antagonists – an alternative to PPIs – and antacids. Meanwhile, if your ulcer has been caused by taking NSAIDs you may need to stop taking them and take a different painkiller such as paracetamol (though your doctor may switch you to a different type of NSAID that’s less likely to cause problems, such as a COX-2 inhibitor).
 
Surgery to remove stomach ulcers is used rarely today  – though you may need an operation if you develop a stomach ulcer complication such as severe bleeding, perforation or gastric outlet obstruction that needs urgent treatment.
 

How can you help yourself?

 
If you’re diagnosed with a stomach ulcer, your doctor may recommend one or two lifestyle changes that may be helpful to your recovery. For instance now may be a good time to quit smoking if you’re a smoker, since smoking can make the symptoms of a stomach ulcer worse. Cutting down on alcohol may also be useful if you often drink heavily – for tips on cutting down read our guide to alcohol misuse. 
 
Being overweight can aggravate a stomach ulcer too, so your doctor may also give you information on getting down to a healthier weight (read our article Weight loss: the facts to find out more about the benefits of keeping your weight down and tips on how to achieve it).
 
And despite the fact that there’s no strong evidence for it, you may notice that certain foods make your symptoms worse – if you can’t quite pinpoint the culprits, try keeping a food diary and list everything you eat when you eat it, and also make a note of your symptoms. Foods that could possibly make stomach ulcer symptoms worse vary from one person to the next, but in general the following are thought to be common triggers (though bear in mind that you may well find you’re fine with these but other foods are a problem):
 

• Milk

• Spicy foods

• Sour foods

• Fatty foods

• Chocolate

• Tomatoes

• Citrus

• Coffee and other caffeinated drinks

 
It may also be a good strategy to eat smaller but more frequent meals throughout the day, and to eat your evening meal at least three or four hours before you go to bed (don’t forget to avoid late-night snacking too). Try to eat more slowly if you can, and if possible relax for a while after eating to give your gut a chance to digest your food more effectively.
 
Even if you don’t find that certain foods trigger your symptoms it’s worth remembering that eating healthily is something we should all do for our health and wellbeing – this includes making sure we eat plenty of fruit, vegetables and fibre, as well as foods that help boost the healthy bacteria in our guts (read our guides to  the benefits of live bacteria and prebiotics for more details). 
 

Can supplements help?

 
As well as eating healthily and avoiding or limiting foods you’ve discovered may aggravate your symptoms, you may wish to try:
 
Live bacteria   Often called probiotics, live cultures and ‘good’ or ‘friendly’ bacteria, live bacteria supplements are thought to offer a range of benefits for health and wellbeing, with a few studies suggesting these benefits may include the eradication of H. pylori bacteria (ix). Live bacteria are found in certain foods, including fermented foods such as live yoghurt, kefir, sauerkraut and kimchi. But you can also get them in supplement form – read our article What are the benefits of live bacteria? to find out more about live bacteria supplements and how to choose one.
 

Want to know more?

 
There are lots of things that can upset your tummy and make you feel unwell or uncomfortable. If you’re looking for information about conditions that affect your stomach and other aspects of your digestive health, take a look at the articles in the digestive health section of our pharmacy health library. 

References:

1. Available online: https://patient.info/digestive-health/dyspepsia-indigestion/stomach-ulcer-gastric-ulcer.

2. Available online: https://www.niddk.nih.gov/health-information/digestive-diseases/peptic-ulcers-stomach-ulcers/definition-facts.

3. Available online: https://patient.info/doctor/peptic-ulcer-disease.

4. Available online: https://www.ncbi.nlm.nih.gov/books/NBK537128/.

5. Available online: https://cks.nice.org.uk/topics/dyspepsia-proven-peptic-ulcer/background-information/prevalence/.

6. Available online: https://www.nhs.uk/conditions/stomach-ulcer/complications/.

7. Available online: https://patient.info/digestive-health/dyspepsia-indigestion/helicobacter-pylori.

8. Available online: https://gi.org/topics/peptic-ulcer-disease/.

9. Boltin D. (2016) "Probiotics in Helicobacter pylori-induced peptic ulcer disease." Best Pract Res Clin Gastroenterol. 30(1):99-109. Available online: https://www.sciencedirect.com/science/article/abs/pii/S1521691815001675?via=ihub.
   
   Ruggiero P. (2014) "Use of probiotics in the fight against Helicobacter pylori." World J Gastrointest Pathophysiol. 5(4):384-391. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4231502/.
   
   Fengzhen Ma et al. (2015) "Probiotics in the treatment of peptic ulcer infected by Helicobacter pylori and its safety." Pak J Pharm Sci. 28(3 Suppl):1087-1090. Available online: https://www.researchgate.net/publication/277894222_Probiotics_in_the_treatment_of_peptic_ulcer_infected_by_helicobacter_pylory_and_its_safety.

 

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Disclaimer: The information presented by Nature's Best is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.

 

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