Stomach ulcer

Stomach ulcer (gastric ulcer) | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Stomach, liver and gastrointestinal tract Stomach ulcer Stomach ulcer About stomach ulcers Stomach ulcer symptoms Stomach ulcer causes Stomach ulcer diagnosis Stomach ulcer treatment Stomach ulcer complications About stomach ulcers Stomach ulcers (gastric ulcers)are open sores that develop on the lining of the stomach. Ulcers can also occur in part of the intestine just beyond the stomach. These are called duodenal ulcers. Stomach and duodenal ulcers are sometimes called peptic ulcers. This information applies to both. Symptoms of stomach ulcers Although the most common symptom of a stomach ulcer is a burning or gnawing pain in the centre of the abdomen (tummy). Not all stomach ulcers are painful. Some people experience: indigestion heartburn nausea (feeling sick) You should speak to your GP if you think you have a stomach ulcer. More about the symptoms of a stomach ulcer Get urgent medical advice Speak to your GP immediately (or phone 111) if: your symptoms persist youre vomiting blood  the blood can appear bright red or have a dark brown, grainy appearance like coffee grounds youre passing dark, sticky, tar-like stools you feel a sudden, sharp pain in your tummy that gets steadily worse These could be a sign of a serious complication. What causes stomach ulcers? Stomach ulcers occur when the layer protecting the stomach lining from stomach acid breaks down. This allows the stomach lining to become damaged. This is usually caused by: an infection with Helicobacter pylori (H. pylori) bacteria taking non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or aspirin  particularly if theyre taken for a long time or at high doses Theres little evidence that stress or certain foods causes stomach ulcers. More about the causes of stomach ulcers Treating stomach ulcers Youll be treated using antibiotics if your ulcer was caused by a H. pylori infection. This kills the bacteria and should prevent the ulcer coming back. Youll be treated using a proton pump inhibitor (PPI) if your ulcer was caused by NSAIDs. Your doctor will prescribe these and discuss whether you should keep using NSAIDs. Alternative medication to NSAIDs, such as paracetamol , may be recommended. Most stomach ulcers take a few months to heal after treatment. However, stomach ulcers can come back after treatment, although this is less likely to happen if the underlying cause is addressed. More about treating stomach ulcers Complications Complications are rare but can be very serious and potentially life-threatening. The main complications include: bleeding at the site of the ulcer the stomach lining at the site of the ulcer splits open  known as perforation the ulcer blocks the movement of food through the digestive system  known as gastric obstruction More about the complications of stomach ulcers Stomach ulcer symptoms The most common symptom of a stomach ulcer is a burning or gnawing pain that develops in your abdomen (tummy). However, some stomach ulcers arent painful and are only noticed when a complication develops, such as bleeding from the ulcer. Tummy pain The pain caused by a stomach ulcer can either travel: out from the middle of your tummy up to your neck down to your belly button through to your back And: can last from a few minutes to a few hours often starts within a few hours of eating can cause you to wake up during the night Taking antacids (indigestion medication) may temporarily relieve the pain, but it will keep coming back if the ulcer isnt treated. Less common symptoms Less common symptoms of a stomach ulcer include: indigestion heartburn loss of appetite feeling and being sick weight loss Some people also find they burp or become bloated after eating fatty foods. Stomach ulcer causes Stomach ulcers are usually caused by Helicobacter pylori (H. pylori) bacteria or non-steroidal anti-inflammatory drugs (NSAIDs). These can break down the stomachs defence against the acid it produces to digest food. The stomach lining then becomes damaged causing an ulcer to form. H. pylori bacteria H. pylori bacteria live in the stomach lining. The bacteria can irritate the stomach lining and make it more vulnerable to damage from stomach acid. Infections are common. Its possible to be infected without realising it because the infection doesnt usually cause symptoms. People of all ages can be infected. Its not clear exactly why some people are more vulnerable to the effects of H. pylori bacteria than others. Non-steroidal anti-inflammatory drugs ( NSAIDs) NSAIDs are medicines widely used to treat pain, a high temperature (fever) and inflammation (swelling). Commonly used NSAIDs include: ibuprofen aspirin naproxen diclofenac Many people take NSAIDs without having any side effects. But theres always a risk the medication could cause problems, such as stomach ulcers, particularly if taken for a long time or at high doses. You may be advised not to use NSAIDs if you currently have a stomach ulcer or if youve had one in the past. Paracetamol is a safer painkiller to use. More about NSAIDs Lifestyle factors Theres little evidence that stomach ulcers are caused by: spicy foods stress alcohol But these can make the symptoms worse. However, smoking can: increase your risk of developing stomach ulcers make treatment less effective Stomach ulcer diagnosis If your GP thinks you have an ulcer, they will want to know if youre taking non-steroidal anti-inflammatory drugs (NSAIDs) might test you for an Helicobacter pylori (H. pylori) infection In some cases, you may be referred for a gastroscopy to look for an ulcer inside your stomach. Testing for H. pylori infection If your GP thinks your symptoms might be caused by an H. pylori infection, youll be offered a: urea breath test stool antigen test  a small stool sample is tested for the bacteria blood test Urea breath test Youll be given a special drink containing a chemical thats broken down by H. pylori. Your breath is then analysed to see whether or not you have an H. pylori infection. Blood test A sample of your bloods tested for antibodies to the H. pylori bacteria. Antibodies are proteins produced naturally in your blood to help fight infection. This tests now largely been replaced by the stool antigen test More about blood tests Gastroscopy A gastroscopy is a procedure that involves passing a thin, flexible tube (an endoscope) with a camera at one end into your mouth and down into your stomach and first section of the small intestine (duodenum). You may: be given a mild sedative injection before the procedure have your throat sprayed with a local anaesthetic to make it more comfortable to pass the endoscope The images taken by the camera will usually confirm or rule out an ulcer. A small tissue sample may also be taken from your stomach or duodenum to test for the H. pylori bacteria. Youll have this procedure as an outpatient in hospital. This means you wont have to spend the night. You may have a repeat gastroscopy after 4 to 6 weeks to check that the ulcers healed. Stomach ulcer treatment If you have a stomach ulcer, your treatment will depend on what caused it. With treatment, most ulcers heal in a month or two. Treating Helicobacter pylori (H. pylori) infection If your stomach ulcers caused by a Helicobacter pylori (H. pylori) bacterial infection, youll be given: a course of antibiotics a medication called a proton pump inhibitor (PPI) This is also recommended if its thought your stomach ulcers caused by a combination of an H. pylori infection and non-steroidal anti-inflammatory drugs (NSAIDs). Antibiotics If you have an H. pylori infection, youll usually be prescribed a course of 2 or 3 antibiotics. The most commonly used antibiotics are: amoxicillin clarithromycin metronidazole You should take these twice a day for a week. Side effects The side effects of these are usually mild, but can include: feeling and being sick diarrhoea a metallic taste in your mouth Further testing Youll be re-tested at least 4 weeks after finishing your antibiotic course to see if there are any H. pylori bacteria left in your stomach. If there are, a further course of eradication therapy using different antibiotics may be given. Ulcers caused by NSAIDs If your stomach ulcers caused by taking NSAIDs: youll be given a course of PPI medication your use of NSAIDs will be reviewed, and you may be advised to use an alternative painkiller Alternative painkillers You may be advised to use an alternative painkiller not associated with stomach ulcers, such as paracetamol . COX-2 inhibitorsare sometimes recommended. These are an alternative type of NSAID thats less likely to cause stomach ulcers. Low-dose aspirin If youre taking low-dose aspirin to reduce your risk of blood clots, your GP will tell you whether you need to keep taking it. If you do, you may also be prescribed long-term treatment with a PPI or H2-receptor antagonist to prevent further ulcers. Complications Its important to understand the potential risks associated with continued NSAID use. Youre more likely to develop another stomach ulcer and could experience a serious complication, such as internal bleeding. Read more about the complications of stomach ulcers Proton pump inhibitors (PPIs) PPIs work by reducing the amount of acid your stomach produces. This prevents further damage to the ulcer as it heals naturally. The most commonly used PPIs are: omeprazole pantoprazole lansoprazole Theyre usually prescribed for 4 to 8 weeks. Side effects Side effects of these are usually mild, but can include: headaches diarrhoea or constipation feeling sick abdominal (tummy) pain dizziness rashes These should pass once treatment has been completed. H2-receptor antagonists Sometimes a type of medication called H2-receptor antagonists are used instead of PPIs. These also reduce the amount of acid your stomach produces. Ranitidine is the most widely used H2-receptor antagonist for treating stomach ulcers. Side effects Side effects are uncommon, but can include: diarrhoea headaches dizziness rashes tiredness Antacids and alginates As these treatments can take several hours before they start to work, your GP may recommend taking additional antacid medication. Antacids: neutralise your stomach acid provide immediate, but short-term, symptom relief should be taken when you experience symptoms or when you expect them, such as after meals or at bedtime Some antacids also contain a medicine called an alginate, which produces a protective coating on the lining of your stomach. Antacids containing alginates are best taken after meals. You can buy these medications at pharmacies. Your pharmacist can tell you which is most suitable for you. Side effects Side effects of both medications are usually mild, but can include: diarrhoea or constipation farting stomach cramps feeling and being sick Lifestyle changes There arent any special lifestyle measures you need to take during treatment. However, avoiding stress, alcohol, spicy foods and smoking may reduce your symptoms while your ulcer heals. Stomach ulcer complications Complications of stomach ulcers are rare, but can be very serious. The main complications are: internal bleeding perforation  the lining of the stomach splits open gastric outlet obstruction  the stomach ulcer obstructs the normal passage of food through your digestive system Internal bleeding Internal bleedings the most common complication of stomach ulcers. It can occur when an ulcer develops at the site of a blood vessel. The bleeding can either be slow and long-term, or rapid and severe. Slow, long-term bleeding Slow, long-term bleeding can lead to anaemia. Symptoms of anaemia include: fatigue breathlessness pale skin heart palpitations (noticeable heartbeats) You should visit your GP if you have persistent symptoms of anaemia. If they think you have a stomach ulcer, they may refer you to a gastroenterologist for an examination and treatment. More about anaemia Severe bleeding Contact your GP or the NHS 24 111 service immediately if you have symptoms of more severe bleeding, including: youre vomiting blood  the blood can appear bright red or have a dark brown, grainy appearance like coffee grounds youre passing dark, sticky, tar-like stools Stopping severe bleeding An endoscopy will be used to identify the cause of the bleeding. Treatment can be given during the endoscopy to stop the bleeding. Sometimes: specialised procedures carried out under X-ray guidance are used to stop bleeding ulcers surgery is needed to repair the affected blood vessel Blood transfusions may also be needed to replace the blood youve lost. Perforation Perforations are a rarer complication of stomach ulcers. This is when the lining of the stomach splits open. This can be very serious because it lets the bacteria that live in your stomach escape and infect the lining of your abdomen (peritoneum). This is known as peritonitis. Peritonitis In peritonitis, an infection can rapidly spread into the blood ( sepsis ) before spreading to other organs. This carries the risk of multiple organ failureand can be fatal if left untreated. The most common symptom of peritonitis is sudden abdominal pain, which gets steadily worse. If you have this type of pain, contact your GP or the NHS 24 111 service immediately. Peritonitis is a medical emergency that requires hospital admission. In some cases, surgery may be needed. Gastric outlet obstruction In some cases, an inflamed (swollen) or scarred stomach ulcer can obstruct the normal passage of food through your digestive system. This is called a gastric outlet obstruction. Symptoms include: vomiting large amounts of undigested food a constant feeling of bloating or fullness feeling more full than usual after eating less food unexplained weight loss Treating a gastric outlet obstruction An endoscopy can be used to confirm the obstruction. If the obstructions caused by inflammation, proton pump inhibitors (PPIs) or H2-receptor antagonists can be used to reduce stomach acid levels until the swelling goes down. If the obstructions caused by scar tissue, surgery may be needed. This can involve passing a small balloon through an endoscope and inflating it to widen the site of the obstruction. Source: NHS 24 - Opens in new browser window Last updated: 13 December 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. 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