Understanding Peptic Ulcers (Stomach Ulcers): A Guide for Patients

Contrary to popular belief, peptic ulcers are rarely caused by stress or spicy food alone, though these factors can certainly worsen symptoms. The two most common causes are:

1. Helicobacter pylori (H. pylori): A bacterial infection that inflames the stomach lining and breaks down its protective barrier.

2. NSAIDs (Non-Steroidal Anti-Inflammatory Drugs): Long-term or frequent use of pain relievers such as Ibuprofen (Nurofen), Aspirin, or Diclofenac (Voltaren). These medications can inhibit the body's ability to produce the protective mucus lining.

In addition, smoking increases risk of developing ulcers, and slows the healing if you develop one.

The most frequent symptom is "gnawing" or burning abdominal pain.

• Timing of Pain: Gastric ulcer pain often occurs shortly after eating. Duodenal ulcer pain often occurs when the stomach is empty (between meals or at night) and may improve temporarily after eating.

• Bloating and Nausea: Feeling prematurely full or experiencing a dull ache.

• Acid Reflux: Heartburn or indigestion.

• Fatigue and tiredness, especially if ulcers cause blood loss and lead to anaemia.

To confirm the presence of an ulcer and rule out other conditions, a Gastroscopy is the gold standard investigation.

Gastroscopy allows for direct visualisation of the ulcer. Small tissue samples (biopsies) can be obtained to check for H. pylori and to ensure the ulcer is not cancerous (particularly for gastric ulcers).

Treatment is focused on eliminating the cause and reducing acidity to allow the tissue to heal.

• Acid Suppression: Most patients are prescribed a Proton Pump Inhibitor (PPI), such as Omeprazole or Pantoprazole. This significantly reduces acid production, providing the environment necessary for healing.

• Eradication Therapy: If H. pylori is detected, a course of antibiotics will be prescribed.

• Medication Review: If the ulcer was caused by NSAIDs, this would ideally need to be stopped, and alternative pain killers needed.