What are peptic ulcers?

Peptic ulcers are small holes in the lining of your stomach or gut. There are several types and they are named according to where they are. Duodenal ulcers which are in the upper part of the small intestine (gut) near the stomach are the most common. They are more likely in men aged between 30 and 50 years. Stomach or gastric ulcers which are in the stomach are the second most common and most often affect middle aged or elderly women.

Why did I get them?

Stress has always been considered the main reason people get ulcers. However, recent studies have shown that over 95% of duodenal ulcers and 80% of gastric ulcers are caused by infection with a bacteria called Helicobacter pylori (H. pylori). The infection is very common and is usually picked up in childhood. While many people are infected, only 15% will go on to have ulcers. The next most common cause of ulcers is taking a lot of anti-inflammatory drugs, usually for fever, headache or arthritic conditions.

Smoking increases the risk of getting an ulcer and makes healing slower.

While emotional stress is no longer considered a cause of ulcers, it can make the pain worse. Physical stress such as major surgery or burns, however, can increase the risk of gastric ulcers. Alcohol was also thought to be a cause of ulcers but this theory has also been proved wrong by studies. However, people with liver damage from drinking or other problems are more likely to get ulcers.

What happens?

The bacteria make a substance that damages the mucous lining of the stomach so that it can be damaged by acids that break down food during digestion. The bacteria also make the body produce more acid which makes the problem even worse. Anti-inflammatory drugs can work in a similar way, leaving the stomach open to attack from digestive acids.

How are they diagnosed?

An x-ray may be taken of your stomach and gut, an endoscope (an instrument for viewing the inside of the body) may be put into your stomach to look for ulcers, and tests may be done on your stomach acids and stools. You may also be asked to blow into a special tube or have your blood tested to see if you have H. pylori infection.

What will I feel?

Gastric ulcers usually cause heartburn and indigestion. There can be a gnawing pain and a feeling of bloating in your upper abdomen which can be worse after a large meal. Some people lose weight.

Duodenal ulcers cause heartburn and pain in the middle abdomen. The pain is relieved by food, so some people with this type of ulcer put on weight. The pain is usually worse when you are hungry, eat acidic food, drink coffee or alcohol or take an aspirin. Night pain is common, but vomiting, severe pain and blood in the stools are rare and should be reported to your doctor.

What makes it better?

• eating a well-balanced diet and having regular meals
• taking antacids
• not taking aspirin or other anti-inflammatory pills if possible
• stopping smoking
• avoiding eating too much, having late night snacks or skipping meals (don't get hungry)
• identifying and avoiding foods and drinks that make the pain worse
• reducing stress.

How can my doctor help?

There are a number of very effective drugs now used to treat ulcers. If you have H. pylori infection you will have a course of antibiotics and special drugs that protect the lining of your gut and stop your body producing too much acid (called triple therapy). It is usually only needed for about two weeks and is very effective. The latter two types of drug may also be used for ulcers that are not caused by infection. Occasionally, surgery may be needed to stop bleeding or to fix ulcers completely.

What happens if they are not treated?

Ulcers are not usually life-threatening. However, in some people they may bleed, perforate (make a hole in the stomach or the duodenum so food and bacteria go into the abdomen) or the area around them may become scarred, blocking up the intestines. If you have black tarry stools, vomit blood, feel dizzy when you stand up or faint; or feel sharp, sudden, severe pain; or vomit what you have just eaten, you must see a doctor immediately.

Written by Anna Mickell RCpN. Reviewed by everybody.