Peptic Ulcer Disease
Treatment of ulcers in the stomach or upper small intestine and their underlying causes
What is peptic ulcer disease?
The stomach makes acid strong enough to strip the tissue that holds it, and protects itself with a layer of mucus and bicarbonate that is renewed constantly. An ulcer is what happens when that defence is beaten locally and the acid reaches raw tissue underneath.
Two things beat it in the great majority of cases. One is Helicobacter pylori, a bacterium that lives in the mucus layer and is common in India, and the other is regular use of anti-inflammatory painkillers, which switch off the chemical signal that maintains the lining. Alcohol and smoking make both worse. Stress and spicy food are widely blamed and are not the cause.
Ulcers heal well once the cause is removed, and they come back reliably if it is not. Treating the acid without treating the bacterium buys months.
What you might notice
- Vomiting blood, or something like coffee grounds
- Gnawing pain in the upper abdomen
- Black, tarry stool
- Burning behind the breastbone
- Feeling full after a few mouthfuls
- Nausea
How it is diagnosed
Helicobacter is tested for in almost everyone, by a breath test, a stool test or a sample taken from the stomach lining. Acid-suppressing tablets and recent antibiotics make all of these read falsely negative, so they are stopped for two weeks first.
A direct look at the stomach lining is arranged when someone is over the middle years, when there is weight loss, difficulty swallowing, a low haemoglobin or vomiting, or when a course of treatment has not worked. It shows the ulcer, its depth, and whether a vessel is exposed in its base.
An ulcer in the stomach is sampled and looked at again after treatment, because a cancer can look exactly like a benign ulcer to the naked eye and is separated from one only by the microscope. Duodenal ulcers are almost never cancerous and are not routinely rechecked.
Recovery
Acid suppression heals a duodenal ulcer in about four weeks and a stomach ulcer in about eight. Comfort returns within days, well before healing is complete, and stopping early is the commonest reason for a relapse.
When Helicobacter is found, two antibiotics are given with the acid tablets for two weeks. The course has to be finished, and a test to confirm the bacterium has gone is done four weeks after the last tablet.
If the ulcer has bled, you are kept in and watched for a couple of days, since the risk of bleeding again is highest in that window. Anti-inflammatory painkillers are stopped for good where possible, and paracetamol takes their place.
If it is left untreated
An ulcer that is settled and has had its cause removed needs nothing further. That is the usual outcome.
An untreated one erodes deeper. If it reaches a vessel it bleeds, which shows as black tarry stools or vomited blood and can be sudden and heavy. If it goes through the full thickness of the wall it perforates, and stomach contents enter the abdomen, which produces severe pain and needs an operation the same day.
A chronic ulcer near the outlet of the stomach can also scar as it heals and narrow the exit, so meals sit and come back hours later. And a stomach ulcer that is never sampled leaves the one question that mattered unanswered.
Questions about peptic ulcer disease
Does spicy food cause ulcers?
No. Ulcers are caused by Helicobacter pylori infection or by regular anti-inflammatory painkillers in the great majority of cases, and much less often by conditions that drive acid production very high. Spicy food can irritate an ulcer that already exists, so avoiding it while you heal is reasonable, but it neither creates one nor keeps one open. The same goes for stress.
Why do I need a repeat endoscopy for a stomach ulcer?
Because an early cancer of the stomach can look identical to a simple ulcer, and the difference is settled by the microscope and by whether the ulcer heals. Biopsies are taken at the first endoscopy, and the lining is looked at again after eight to twelve weeks of treatment to confirm it has healed completely. Ulcers in the duodenum behave differently, are almost never cancerous, and are not rechecked as a routine.
Can an ulcer come back after it is treated?
It can, and the risk turns almost entirely on whether the cause was dealt with. If Helicobacter was found and cleared, and clearance was confirmed by a test a month after the antibiotics, recurrence is uncommon. If you go back to regular anti-inflammatory painkillers, expect it to return, so those are stopped where the joint pain allows, or covered with an acid-suppressing tablet where they cannot be.
Other gastroenterology treatments
Management of acid reflux and heartburn that persist, recur frequently or affect daily life
Day CareDiagnosis and treatment of inflammation of the stomach lining
Day CareTalk to a care coordinator about peptic ulcer disease
Leave a number and a care coordinator calls you back with what the treatment involves and which hospital it would be at. They book a consult only if you want one