Peptic Ulcer

An eroded area of the tissue lining the stomach or the duodenum, the first part of the small intestine

  • Stomach ulcers are more common over the age of 50; duodenal ulcers are most common between the ages of 20 and 60
  • Peptic ulcers are more common in females
  • Sometimes runs in families
  • Use of aspirin and other nonsteroidal anti-inflammatory drugs, excess alcohol, smoking, and unsanitary conditions are risk factors

The lining of the stomach and duodenum normally has a barrier of mucus to protect it from the effects of acidic digestive juices. If this barrier is damaged, the acid may cause inflammation and erosion of the lining. The resulting eroded areas are known as peptic ulcers, of which there are two types: duodenal ulcers and gastric (stomach) ulcers. Duodenal ulcers are more common than gastric ulcers and usually occur in people aged 20 to 60. Gastric ulcers are more common in people over the age of 50. Peptic ulcers are common, and it is estimated that about 1 in 10 people in the UK develops an ulcer at some time.

What are the causes?

Peptic ulcers are most commonly associated with Helicobacter pylori infection. This bacterium is thought to be transmitted most easily in unsanitary living conditions and releases substances that reduce the effectiveness of the mucous layer. Acidic digestive juices are then able to erode the protective lining of the stomach or the duodenum, thereby allowing peptic ulcers to develop.

Peptic ulcers may sometimes result from the long-term use of nonsteroidal anti-inflammatory drugs, such as ibuprofen or aspirin, that damage the lining of the stomach. Other factors that may lead to peptic ulcers include smoking and consumption of alcohol. In some people, there is a strong family history of peptic ulcers, suggesting that a genetic factor may be involved in their development. It used to be thought that stress could cause peptic ulcers but this is now no longer considered to be a significant causative factor.

What are the symptoms?

Many people with a peptic ulcer do not experience symptoms or dismiss their discomfort as indigestion. Those with persistent symptoms may notice:

  • Pain or discomfort that is felt in the upper abdomen.

  • Loss of appetite and weight loss.

  • A feeling of fullness in the abdomen.

  • Nausea and sometimes vomiting.

Pain is often present for several weeks and then disappears for months or even years. The pain from a duodenal ulcer can be worse before meals when the stomach is empty. This pain may be quickly relieved by eating but usually recurs a few hours afterwards. By contrast, pain caused by a gastric ulcer is often aggravated by food.

Are there complications?

The most common complication of a peptic ulcer is bleeding as the ulcer becomes deeper and erodes into nearby blood vessels (see Bleeding from the digestive tract). Minor bleeding from the digestive tract may cause no symptoms apart from those of iron-deficiency anaemia, such as pale skin, tiredness, and faintness. Bleeding from the digestive tract may lead to vomiting of blood. Alternatively, blood may pass through the digestive tract, resulting in black, tarry stools. In some cases, an ulcer perforates all the layers of the stomach or duodenum, allowing gastric juices to enter the abdomen and causing severe pain (see Peritonitis). Bleeding from the digestive tract and perforation of the stomach or the duodenum may be life-threatening and require immediate medical attention.

In rare cases, stomach ulcers may result in narrowing of the stomach outlet into the duodenum, which prevents the stomach from emptying fully. Symptoms may then include bloating after meals, vomiting undigested food hours after eating, and weight loss.

What might be done?

If your doctor suspects that you have a peptic ulcer, he or she may arrange an endoscopy (see Upper digestive tract endoscopy) to view the stomach and duodenum. During endoscopy, a sample of the stomach lining may be taken to look for evidence of H. pylori infection and exclude stomach cancer, which may cause similar symptoms. Your doctor may also arrange for a faecal, blood, or breath test to look for H. pylori infection, and blood tests to check for evidence of anaemia.

Treatment of a peptic ulcer is designed to heal the ulcer and to prevent it from recurring. You will be advised to make some lifestyle changes, such as giving up smoking and drinking less alcohol.

If H. pylori is found, a combination of antibiotics and ulcer-healing drugs will usually be prescribed. Ulcer-healing drugs are usually given to maximize the chance of healing even if tests for H. pylori prove negative.

If long-term treatment with aspirin or another nonsteroidal anti-inflammatory drug is the cause, your doctor may prescribe an alternative or an additional drug, such as omeprazole, to protect the lining of the stomach and duodenum.

A bleeding or perforated ulcer is an emergency requiring urgent admission to hospital. If bleeding is moderate, it can usually be stopped by injections of drugs. If blood loss is severe, a blood transfusion may be necessary. Endoscopy may be used to view the stomach lining; during this procedure, bleeding blood vessels can be sealed off. If the bleeding is severe or the ulcer is perforated, surgery is usually necessary.

With treatment, about 19 in 20 peptic ulcers disappear completely within a few months. However, an ulcer may recur if lifestyle changes are not made, if nonsteroidal anti-inflammatory drugs continue to be used, or if H. pylori is not eradicated or reinfection occurs.



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