Ulcers

What is a Peptic Ulcer?

A peptic ulcer is a sensitive raw patch, like a mouth ulcer but larger, which forms a break in the lining of the stomach (gastric ulcer) or duodenum (duodenal ulcer).

How is an Ulcer Formed?

Ulcers occur when the normal defence mechanisms of the stomach or duodenal lining fail, allowing hydrochloric acid and other digestive juices to “eat” away at the lining.
In many cases, a bacterium called helicobacter pylori is the cause of the ulcer.  This bacterium is commonly found in the stomach lining of some people, and it is now certain that having this germ makes the chance of developing ulcers more likely.  Almost all patients with duodenal ulcers and many with gastric ulcers have helicobacter present.
Another important cause of ulcers is the group of drugs used in the treatment of pain, particularly arthritis and rheumatism, called non-steroidal anti-inflammatory drugs (NSAIDs).  Aspirin is one of this group.
Stress probably does not cause ulcers, but does worsen symptoms if an ulcer is present.

How is an Ulcer Diagnosed?

A Gastroscopy is performed to examine the lining of the oesophagus (gullet), stomach and duodenum.  Tissue samples (biopsies) are also taken and tested for helicobacter pylori.

How can an Ulcer be Treated?

The aim of treatment is to:

  • Eradicate helicobacter pylori infection if it is present.  Combinations of drugs including antibiotics are used in a comprehensive course.
  • Reduce stomach acid to allow healing of the stomach and duodenal lining.  Drugs do this by inhibiting the cells which produce gastric acid.
    Most ulcers heal in 4 – 8 weeks, but they are very likely to come back in the future unless h.pylori infection has been successfully treated.

Are there any Side Effects from Ulcer Treatment?

Generally ulcer drugs have few side effects.  Some antacids may cause constipation, others may cause diarrhoea.  Antibiotic treatments may cause mild stomach upsets. They are usually given for 1 – 2 weeks.

How can Ulcers be avoided?

  • Don’t smoke – smoking slows healing of the ulcers and is, of course, a health risk.
  • Avoid aspirin or NSAIDs e.g. Voltaren.  These drugs prevent the formation of protective substances in the stomach lining and can cause ulcers to bleed.  Instead, use paracetamol.  Patients who have to take aspirin or NSAIDs regularly, e.g. for arthritis, should discuss with their doctor how to minimise the effects on their stomach and duodenum.