Peptic ulcers
Ulcers of the small intestine are known as duodenal ulcers. Duodenal ulcers affect about one in 10 people at some point in their lives, usually between the ages of 45 and 65. Stomach ulcers are less common, and usually affect people aged over 65.
Other symptoms may include:
- belching
- heartburn
- general discomfort in the abdomen
- bloating or fullness after eating
- feeling sick
- vomiting
Bleeding : Occasionally ulcers can cause the lining of the stomach or duodenum to bleed. If this happens, you will need hospital treatment.
A bleeding ulcer will give symptoms that include:
- vomiting blood (usually bright red)
- vomit containing dark brown bits of clotted blood (with an appearance like ground coffee)
- blood in the faeces (usually dark red)
- black, tarry faeces
Anaemia : If the bleeding from the ulcer is slow, you might not get blood in your vomit or faeces. However, you may develop anaemia. This is a condition where there are not enough red blood cells to carry oxygen around the body.
Perforation : Rarely, the ulcer may erode very deeply into the wall of the stomach or duodenum, leaving a hole into the abdomen. This causes severe pain and needs emergency surgery. However, because treatment with medicine is usually successful, surgery is now rarely needed for peptic ulcers.
Causes : The following are the most important causes of peptic ulcers.
- The most common cause is infection of the stomach with bacteria called Helicobacter pylori or H. pylori. This infection is quite common; about half of the world's population is infected. These bacteria cause the stomach to make too much acid, which damages the lining of the stomach or duodenum and can cause the ulcer.
- Some medicines, called non-steroidal anti-inflammatory drugs (NSAIDs), can cause peptic ulcers. Examples of these medicines include aspirin, ibuprofen, naproxen and diclofenac. However most people can take these safely. If you are in doubt which painkillers to take, ask your pharmacist.
- Smoking and drinking excessive alcohol increase your chances of developing a peptic ulcer.
Diagnosis : If you have a suspected peptic ulcer, your doctor may recommend some of the following tests to diagnose and to decide how to treat you.
H. pylori test : As H. pylori is the commonest cause of a peptic ulcer, your doctor may test for and prescribe medicines to remove the bacteria if it's found to see if your symptoms improve.
Testing for H. pylori is done with either a breath, blood or faeces (stool) test. For the breath test, you are given a liquid to swallow that is broken down by the H. pylori bacteria to produce a gas. Your breath is then tested for this gas by a machine. If the gas is found, H. pylori are present.
For the other tests, a sample of blood or your faeces is sent off to a laboratory for analysis.
If you have been taking an anti-ulcer medicine called a proton pump inhibitor (see Treatment), the breath and faeces test won't be accurate until two weeks after stopping the medicine.
Endoscopy : If you have a suspected peptic ulcer, your doctor may arrange a gastro-intestinal endoscopy. Not everyone who has abdominal pain needs one, so your doctor may decide to investigate you in one of the other ways first. However, endoscopy is the only way to be certain whether you have a peptic ulcer.
During the procedure, a flexible, tube-like instrument called a gastroscope is passed through the mouth and into the stomach, usually under sedation in hospital. The procedure usually lasts a few minutes.
With the instrument the doctor can see the lining of your stomach, and can take a sample of stomach lining or a biopsy with an instrument that is passed down through the tube. This sample is either sent to a laboratory and examined under a microscope, or directly tested for H. pylori.
Barium meal : This involves swallowing a drink containing barium (a substance that shows up on X-rays). X-ray images of your abdomen then show the inside of your bowel more clearly.
Treatment : There are lifestyle changes that you can make to help your ulcers heal and prevent them coming back. These self-help measures include:
- not having food and drink that seems to cause more severe symptoms - these foods can include spicy foods, coffee and alcohol
- stopping smoking
- not taking painkillers that are likely to cause ulcers in the future - your GP or pharmacist can give you advice on other medicines you could take instead
The first group are called H2-blockers. Examples include ranitidine (eg Zantac) and cimetidine (eg Tagamet). These are effective for most people with a peptic ulcer.
There are more powerful medicines called proton pump inhibitors, which can completely stop acid production. Examples include omeprazole (eg Losec) and lansoprazole (eg Zoton).
Any of these medicines will relieve your symptoms, and within a few weeks the ulcer will heal. However, once you stop taking the medicine, the ulcer may come back unless the H. pylori has been treated and removed.
You can buy some of these medicines over the counter to treat indigestion. However, if you think you have an ulcer you should visit your GP for advice.
Treating H. pylori infection : If tests confirm that you have H. pylori, you will be prescribed medicines to treat it. This usually consists of a combination of three medicines: a proton pump inhibitor plus two antibiotics. Treating the H. pylori infection should allow the ulcers to heal and prevents them from coming back
