More about Peptic Ulcer Disease
Types and Causes
Peptic ulcers are breaks in the lining of the stomach and the first part of the
small intestine (duodenum). They are called
gastric ulcers when they are found in
the stomach lining and duodenal ulcers when they occur in the duodenum (see diagram).
Whilst we have known for many years that acid is an important cause of peptic ulcers,
it is now understood that, in most cases, infection of the stomach lining with a
bacterium called Helicobacter pylori (H. pylori) usually makes the stomach and duodenum
more likely to ulcerate.
Ninety five per cent of duodenal ulcers and 70% of gastric ulcers are caused by
H. pylori. Getting rid of (eradicating) this bacterium leads to healing of the ulcers
in the majority of cases. If H. pylori is eradicated from a patient with a duodenal
ulcer, the likelihood of the ulcer coming back falls from 80% within 1 year to under
5%.
Medicines such as aspirin and others used for the treatment of arthritis (e.g. ibuprofen)
may damage the stomach lining and cause ulcers. Because these medicines are known
as Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), the ulcers they cause are called
NSAID-induced ulcers.
Symptoms
The most common symptom of peptic ulcer is hunger-like pain felt in the upper part
of the abdomen.
The symptoms are:
- Often worse in the early hours of the morning
- Usually quickly relieved by antacids or food
- Often accompanied by nausea and vomiting.
Gastric ulcers are often associated with loss of appetite and therefore also weight
loss. If left untreated they can present with potentially serious complications
such as bleeding (vomiting up or passing blood) or perforation (hole in lining),
requiring an emergency operation.
Treatment
Many doctors, when they suspect an ulcer, will test for the presence of the bacterium
H. pylori, usually by a simple breath test or blood test. If the test is positive,
patients are likely to be prescribed an antibiotic-based course of treatment without
further investigation.
H. pylori positive
This treatment (called ‘triple therapy’) is usually a combination of two antibiotics
and a proton pump inhibitor (PPI - to reduce acid production), which needs to be
taken together for 7 days. This may be given to you either as a combination pack
or as separate items. If you have been treated for a peptic ulcer with triple therapy
and you become symptom-free, in the majority of cases no further treatment is necessary.
However if symptoms are not relieved or if they return after the treatment has stopped,
an endoscopy (see this page) and a repeat H. pylori test will probably be arranged.
H. pylori negative
Patients with persistent peptic ulcers in the absence of H. pylori (e.g. after eradication
of H. pylori) are often advised to remain on specific drugs for a long period or
indefinitely.
NSAID-induced
If you have NSAID-induced disease, such as an ulcer or gastritis, your doctor may
advise you to stop taking aspirin or NSAIDs while your stomach is healing. It is
also a good idea to moderate your alcohol intake at this time because the alcohol
will aggravate the unprotected stomach lining.
If you need to take NSAIDs long term for arthritis, but have a tendency to develop
NSAID-induced ulcers, you are likely to be prescribed an acidsuppressing therapy,
such as a PPI, on a long term basis.
It is important to cure ulcers or keep them under control in order to prevent future
complications such as bleeding or perforation.
Because modern drug treatment is so effective for ulcer disease, surgery is hardly
ever needed.
Lifestyle Changes
Lifestyle changes in patients with peptic ulcer disease should include:
- Avoidance of aspirin and NSAIDs where possible (paracetamol may be a useful alternative
for pain and headaches)
- Cessation of smoking
- Reduction of alcohol intake.
There is no evidence that spicy foods, such as curries, make symptoms worse, or
that milk is beneficial (see ‘Helpful Hints’).