Peptic Ulcer Disease

A peptic ulcer is an open sore that develops in the lining of the digestive tract where it is exposed to stomach acid. When the sore is in the stomach it is called a gastric ulcer, and when it is in the first part of the small intestine (the duodenum) it is called a duodenal ulcer.

Ulcers form when the protective lining of the digestive tract is damaged and acid is able to injure the tissue beneath. With the right treatment, most ulcers heal well, but they can cause significant symptoms and, in some cases, serious complications.

The most common symptom is a burning or gnawing pain in the centre or upper part of the abdomen. The pain may come and go, can be worse at night or when the stomach is empty, and is sometimes eased or triggered by eating. Other symptoms include indigestion, heartburn, bloating, nausea, and feeling full quickly.

Some ulcers cause few or no symptoms and are only found when a complication develops. This is one reason why warning signs such as bleeding should never be ignored.

The two main causes are infection with a bacterium called Helicobacter pylori (H. pylori), and the regular use of non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and aspirin. Both can weaken the protective lining of the stomach or duodenum, allowing acid to cause damage.

Smoking can increase the risk and may slow healing. Contrary to a common belief, stress and spicy food do not directly cause ulcers, though they may make symptoms feel worse in some people.

If H. pylori infection is suspected, a doctor may arrange a breath test, a stool test, or sometimes a blood test to check for it. Identifying and treating this infection is an important part of managing many ulcers.

To look directly at the lining of the stomach and duodenum, a doctor may recommend a gastroscopy, in which a thin, flexible tube with a camera is passed down into the stomach. This allows the ulcer to be seen, and samples can be taken if needed.

Treatment depends on the cause. If H. pylori is present, it is usually treated with a combination of antibiotics together with medicine to reduce stomach acid. If NSAIDs are the cause, your doctor will review whether these can be stopped or changed, and may prescribe acid-reducing medicine to help the ulcer heal.

Medicines called proton pump inhibitors are commonly used to lower acid and allow the ulcer to heal, typically over several weeks. It is important to complete the full course of treatment and to follow up as advised, as healing may need to be confirmed in some cases.

Peptic ulcers can sometimes bleed or, less commonly, create a hole in the wall of the stomach or duodenum (perforation). These are dangerous and need emergency care. Seek immediate help if you vomit blood or material that looks like coffee grounds, or if you pass black, sticky, tarry stools.

Sudden, severe abdominal pain, a tummy that is very tender to touch, or feeling faint and unwell can also signal a serious complication. These symptoms require urgent emergency assessment without delay.

You can lower your risk by using anti-inflammatory painkillers only as needed and as advised, and by discussing protective medicine with your doctor if you need them regularly. Not smoking and limiting alcohol also support a healthy stomach lining. If H. pylori is found, treating it helps prevent ulcers from forming or returning.

The outlook is generally good. Most ulcers heal well once the underlying cause is treated. Ulcers can come back, particularly if H. pylori is not fully cleared or NSAID use continues, so following your treatment plan and your doctor's advice is the best way to prevent recurrence.