Information about Peptic ulcers www.corecharity.org.uk What are the symptoms? What are the causes? What are peptic ulcers? When should I consult a doctor? What will the doctor do? How should I treat peptic ulcers? Can peptic ulcers be prevented? Peptic Ulcers explained What is an ulcer? duodenal ulcers. The term peptic ulcer An ulcer is the term used to describe a break includes both gastric and duodenal ulcers. in the lining of any part of the body. This can occur most visibly in the skin, but many What causes a peptic ulcer? people will suffer from mouth ulcers One of the important functions of the affecting their tongue or gums. stomach is to produce acid and a chemical called pepsin, which are important in starting What are peptic ulcers? the digestion of food and preparing it to be Ulcers in the lining of the stomach are called absorbed (taken up) into the body. Acid and gastric ulcers. In the lining of the duodenum, pepsin are not only strong enough to help which is part of the intestine immediately digest food, but they are also capable of below the stomach, they are called attacking the lining of the stomach and duodenum. In a healthy stomach or duodenum the lining defends itself by producing a protective layer of sticky mucous and fluid that protects the lining. An ulcer occurs when the acid and pepsin overcome these natural defences and cause a break in the lining. oesophagus The two most important factors that upset the balance between attack and defence are infection with a bacterium called stomach Helicobacter pylori (also known as H pylori ) and taking non-steroidal anti-inflammatory duodenum drugs (NSAIDs) and aspirin. pancreas What is Helicobacter pylori and how does it cause ulcers? Helicobacter pylori is a bacterium, which is colon small the main cause of peptic ulcers throughout intestine the world. It produces ulceration by: • Infecting and inflaming the stomach rectum and duodenal lining which weakens their defences. anus Core is funded entirely from voluntary contributions, donations and gifts from legacies www.corecharity.org.uk • Disturbing the mechanism which alone, but seem to increase the risk of normally switches off acid and pepsin ulceration if taken in conjunction with production after a meal has been digested. NSAIDs and may be associated with ulceration caused by the condition for Do all of those infected with which the steroids themselves Helicobacter pylori get ulcers? are prescribed. No – the great majority of people infected • Diet: specific foods and beverages do not with Helicobacter pylori have no ulceration or cause ulcers although some may give rise symptoms. Why some people get ulcers and to indigestion in some people and should others do not is still the subject of research. be avoided. • Stress was at one time blamed for peptic How are NSAIDs and aspirin ulcer, but it is no longer thought to be involved? important, apart from the stress caused These drugs are very commonly prescribed. by major surgical operations or trauma. NSAIDs (such as Neurophen) are used for • Inheritance of an ulcer tendency may treating painful conditions whilst aspirin, exist in some families, but is probably particularly in low doses, is widely more often due to H pylori passing from prescribed to protect the blood vessels of one family member to another than an the heart and the circulation around the inherited risk. brain. Unfortunately, both interfere with the gastric and duodenal defences, increasing How do I know if I’ve got an ulcer? the risk of ulceration. Pain in the abdomen (belly) is the most frequent symptom. It is usually: In most developed countries the numbers of • Situated just below the breastbone people infected with H pylori have steadily • Described as gnawing or knife-like, and decreased and in some parts of the world sometimes is felt in the back. NSAIDs are the main cause of peptic ulcers. • Lasts from a few minutes to a few hours at a time, often 1–2 hours after meals. Are there any other causes of • It may wake you at night. peptic ulcers? • Comes on in bouts lasting 2–3 weeks. • Smoking increases the chances of • Is partially relieved by antacids. developing an ulcer and makes treatment • Other symptoms associated with ulcers less effective. include heartburn, nausea and vomiting. • Steroid drugs, such as prednisolone, are not thought to cause ulcers when taken Core is funded entirely from voluntary contributions, donations and gifts from legacies www.corecharity.org.uk Medical advice Although your doctor may suspect an ulcer The views obtained are so good that an on the basis of what you tell them about ulcer can be confirmed or excluded without your symptoms, the diagnosis cannot be the need for further tests. A sample of the confirmed without tests. lining of the stomach will also be taken for microscopic examination and to check Many patients with an ulcer have no for H pylori infection. symptoms at all and only know about it when they develop a complication such as Is there an alternative to bleeding from the ulcer. This can result in endoscopy? vomiting up blood which may have a coffee- There is now good evidence that testing for ground appearance or passing stools which H pylori, and treating it if the test is positive, are entirely black in colour. is an effective alternative to an endoscopy because it is less trouble for patients and What tests are needed? may reduce costs of treatment. The best The most accurate way of confirming a way of testing for H pylori infection is by peptic ulcer is by endoscopy. This involves means of a breath test, in which you will be passing a flexible, thin tube through the asked to swallow a small amount of fluid mouth, down the gullet and into the containing a trace of radioactive urea. stomach and duodenum. Because H pylori splits urea in the stomach into water and carbon dioxide, a measurement of the amount of carbon dioxide in your breath is an indication endoscope of whether or not you have Helicobacter pylori infection. Doing a blood test is a less accurate alternative to a urea breath test. Stool antigen tests, in which a small portion of a oesophagus bowel motion is analysed, are also being developed as tests for H pylori infection. endoscope passed down oesophagus into stomach Barium meals, which are x-ray procedures involving swallowing a white tasteless liquid stomach which outlines the wall of the duodenum and duodenum stomach, are much less often used Core is funded entirely from voluntary contributions, donations and gifts from legacies www.corecharity.org.uk nowadays, although sometimes, depending If the NSAID cannot be stopped these on your symptoms, a barium meal may be drugs will still be effective, but the ulcer may performed instead of an endoscopy. take longer to heal and you will probably have to take an acid suppressing drug, What is the best way of treating probably at a lower dose, indefinitely. an H pylori ulcer? If the ulcer is the result of H pylori infection Will I need another test to prove you will be recommended to take an acid- the ulcer has healed? reducing drug together with two antibiotics For all gastric ulcers and for duodenal ulcers for seven days. Many doctors now advise that have bled or perforated it is routine to this treatment not only for newly diagnosed repeat the endoscopy to confirm healing. ulcers but for patients who continue to have In other patients with duodenal ulcers a symptoms thought to be due to an ulcer further endoscopy is not necessary unless which has been diagnosed in the past. symptoms return. CORE also publishes a leaflet onHelicobacter What about checking that H pylori pylori, containing further information. has been eliminated? Because eradication treatment is effective What can I eat? in approximately 90% of patients the odds You can eat normally, and do not need to are very much on your side. However, if follow a special diet. A healthy diet including symptoms persist you may need a further a wide variety of foods and plenty of fruit test, which will not necessarily be an and vegetables is good for your general endoscopy, but is likely to be a urea breath health. Aim to eat five portions of fruit or test, as described previously. vegetables each day and to drink at least two litres (8–10 cups) of fluid every day. Will the ulcer come back? Further information on healthy eating is H pylori related ulcers very rarely recur available from the Food Standards Agency after the bacterium has been eradicated (www.food.gov.uk). and NSAID ulcers will not return unless the drugs are taken again. What if my ulcer is due to NSAID treatment? Do recurrent symptoms always For NSAID ulcers the most effective mean the ulcer has come back? treatment is to stop the NSAID and take No – in the great majority of patients if an acid suppressing drug for 4–8 weeks. H pylori is treated and NSAIDs are avoided, Core is funded entirely from voluntary contributions, donations and gifts from legacies www.corecharity.org.uk a return of indigestion is usually due to some if possible, and use paracetamol other problem, most often reflux disease. for pain relief. • Remind doctors of your medical Core also publishes a leaflet on Gastro- history if they suggest taking aspirin oesophageal Reflux, containing further or NSAIDs, because safer alternatives information. are now available. • Don’t smoke. Will acid reducing drugs be needed long term? Do peptic ulcers turn into cancer? In a few patients in whom the ulcer is not No due to Helicobacter pylori, or when it proves impossible to eradicate H pylori, these drugs What further research is needed? need to be continued on a long-term basis to We still don’t fully understand why only a prevent relapse.