Some terms explained
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Peptic inflammation
is inflammation caused by stomach acid. Inflammation may be in the
stomach, the duodenum (as acid flows in with food), or the lower
oesophagus (if acid splashes up to cause 'reflux oesophagitis').
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A peptic ulcer is an ulcer caused by stomach acid. An ulcer
is where the lining of the gut is damaged and the underlying tissue is
exposed. If you could see inside your gut, an ulcer looks like a small,
red crater on the inside lining of the gut.
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A stomach ulcer is one type of peptic ulcer. A stomach ulcer
is sometimes called a gastric ulcer. (The most common type of peptic
ulcer is a duodenal ulcer.)
The rest of this leaflet deals only with stomach ulcers. See separate leaflets on 'Duodenal Ulcer', and 'Acid Reflux and Oesophagitis'.
What causes stomach ulcers?
Your
stomach normally produces acid to help with the digestion of food and
to kill bacteria. This acid is corrosive so some cells on the inside
lining of the stomach and duodenum produce a natural mucus barrier
which protects the lining of the stomach and duodenum. There is
normally a balance between the amount of acid that you make and the
mucus defense barrier. An ulcer may develop if there is an alteration
in this balance allowing the acid to damage the lining of the stomach
or duodenum. Causes of this include the following:
Infection with Helicobacter pylori
Infection by Helicobacter pylori (commonly just called H. pylori) is the cause in about 8 in 10 cases of stomach ulcer. More than a quarter of people in the UK become infected with H. pylori
at some stage in their life. Once you are infected, unless treated, the
infection usually stays for the rest of your life. In many people it
causes no problems and a number of these bacteria just live harmlessly
in the lining of the stomach and duodenum. However, in some people this
bacterium causes an inflammation in the lining of the stomach or
duodenum. This causes the defence mucus barrier to be disrupted (and in
some cases the amount of acid to be increased) which allows the acid to
cause inflammation and ulcers.
Anti-inflammatory drugs - including aspirin
Anti-inflammatory
drugs are sometimes called non-steroidal anti inflammatory drugs
(NSAIDs). There are various types and brands. For example: aspirin,
ibuprofen, diclofenac, etc. Many people take an anti-inflammatory drug
for arthritis, muscular pains, etc. Aspirin is also used by many people
to protect against blood clots forming. However, these drugs sometimes
affect the mucus barrier of the stomach and allow acid to cause an
ulcer. About 2 in 10 stomach ulcers are caused by anti-inflammatory
drugs.
Other causes and factors
Other causes are
rare. For example, some virus infections can cause a stomach ulcer.
Crohn's disease may cause a stomach ulcer in addition to other problems
of the gut. Stomach cancer may at first look similar to an ulcer.
Stomach cancer is uncommon, but may need to be 'ruled out' if you are
found to have a stomach ulcer.
What are the symptoms of a stomach ulcer?
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Pain
in the upper abdomen just below the sternum (breastbone) is the common
symptom. It usually comes and goes. It may be eased if you take antacid
tablets. Sometimes food makes the pain worse. The pain may wake you
from sleep.
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Other symptoms which may occur include: bloating, retching, and feeling sick. You may feel particularly 'full' after a meal.
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Complications develop in some cases, and can be serious. These include:
- Bleeding ulcer. This can range from a 'trickle' to a life-threatening bleed.
- Perforation. This is where the ulcer goes right through
('perforates') the wall of the stomach. Food and acid in the stomach
then leak into the abdominal cavity. This usually causes severe pain
and is a medical emergency.
What tests may be done?
-
Endoscopy
is the test that can confirm a stomach ulcer. In this test a doctor
looks inside your stomach by passing a thin, flexible telescope down
your oesophagus. They can see any inflammation or ulcers. (See leaflet
called 'Endoscopy' for details.)
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A test to detect the H. pylori bacterium is usually done if you have a stomach ulcer. If H. pylori is found then it is likely to be the cause of the ulcer. See separate leaflet on Helicobacter Pylori & Stomach Pain
and how it can be diagnosed. Briefly, it can be detected in a sample of
faeces, or in a 'breath test', or from a blood test, or from a biopsy
sample taken during an endoscopy.
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Biopsies (small samples) are usually taken of the tissue in
and around the ulcer during endoscopy. These are sent to the 'lab' to
be looked at under the microscope. This checks for cancer (which is
ruled out as the cause of the ulcer in most cases).
What are the treatments for a stomach ulcer?
Acid suppressing medication
A 4-8 week
course of a drug that greatly reduces the amount of acid that your
stomach makes is usually advised. The most commonly used drug is a
proton pump inhibitor. Proton pump inhibitors (PPIs) are a class
(group) of drugs that work on the cells that line the stomach, reducing
the production of acid. They include: esomeprazole, lansoprazole,
omeprazole, pantoprazole and rabeprazole, and come in various brand
names. Sometimes a drug from another class of drugs called H2 blockers
is used. H2 blockers work in a different way on the cells that line the
stomach, reducing the production of acid. They include: cimetidine,
famotidine, nizatidine and ranitidine, and come in various brand names.
As the amount of acid is greatly reduced, the ulcer usually heals.
However, this is not the end of the story ...
If your ulcer was caused by H. pylori
Most stomach ulcers are caused by infection with H. pylori.
Therefore, a main part of the treatment is to clear this infection. If
this infection is not cleared, the ulcer is likely to return once you
stop taking acid-suppressing medication. Two antibiotics are needed to
clear H. pylori. In addition, you need to take an
acid-suppressing drug to reduce the acid in the stomach. This is needed
to allow the antibiotics to work well. You need to take this
'combination therapy' (sometimes called 'triple therapy') for a week.
One course of combination therapy clears H. pylori infection in up to 9 in 10 cases. If H. pylori is cleared, then the chance of a recurrence of a stomach ulcer is greatly reduced. However, in a small number of people H. pylori infection returns at some stage in the future.
If your ulcer was caused by an anti-inflammatory drug
If
possible, you should stop the anti-inflammatory drug. This allows the
ulcer to heal. You will also normally be prescribed an acid-suppressing
drug for several weeks. This stops the stomach from making acid and
allows the ulcer to heal. However, in many cases the anti-inflammatory
drug is needed to ease symptoms of arthritis or other painful
conditions, or aspirin is needed to protect against blood clots. In
these situations, one option is to take an acid-suppressing drug each
day indefinitely. This reduces the amount of acid made by the stomach,
and greatly reduces the chance of an ulcer forming again.
Treatment for other uncommon causes
Treatment depends on the underlying cause.
Surgery
In the past, surgery was commonly needed to treat a stomach ulcer. This was before it was discovered that H. pylori
was the cause of most stomach ulcers, and before modern
acid-suppressing drugs became available. Surgery is now usually only
needed if a complication of a stomach ulcer develops such as severe
bleeding or a perforation.
After treatment
A repeat endoscopy is
usually advised a few weeks after treatment has finished. This is
mainly to check that the ulcer has healed, and also to be doubly
certain that the 'ulcer' was not due to stomach cancer. If your ulcer
was caused by H. pylori then a test to check that H. pylori
has gone is usually advised. This is done at least four weeks after the
course of combination therapy has finished. In most cases, the test is
'negative' meaning that the infection has gone. If it has not gone,
then a repeat course of combination therapy with a different set of
antibiotics may be advised.
Disclaimer: This article is for information only and should not
be used for the diagnosis or treatment of medical conditions. EMIS and
PiP have used all reasonable care in compiling the information but make
no warranty as to its accuracy. Consult a doctor or other health care
professional for diagnosis and treatment of medical conditions.
© EMIS and PiP 2008 Reviewed: 24 Jul 2008
