H. pylori and Peptic Ulcers

What is a peptic ulcer?

A peptic ulcer is a sore which forms on the lining of the small intestine (a duodenal ulcer) or stomach (a gastric ulcer). Peptic ulcer disease is a term used to refer to both gastric and duodenal ulcers. It is difficult to say how common peptic ulcers are as many people have them without realising, since there are often no apparent symptoms. Peptic ulcers are most common among people above the age of 60, but they can have an impact on people of all ages and both genders are affected equally.

What causes peptic ulcers?

In the past, lifestyle factors were believed to be a major cause of peptic ulcers, but it is now clear that the two major causes of peptic ulcers are H pylori infection and non-steroidal anti-inflammatory drugs.

H pylori infection: Helicobacter pylori infections are fairly common and many people develop the infection without ever experiencing any symptoms. H pylori infections are believed to cause up to 95% of duodenal and 80% of gastric ulcers. This happens when an infection causes the mucus that protects the lining of the small intestine or stomach to become inflamed, which can cause an ulcer to form.

Non-steroidal anti-inflammatory drugs: NSAIDs are used to treat pain, inflammation and, in the mainstream of cases, they are effective and do not cause any problems. However, long-term use can cause damage to the protective mucus lining of the stomach and small intestine and this can cause ulcers to develop. In rare cases, other forms of medication, including corticosteroids, chemotherapy drugs, bisphosphonates and potassium chloride, can also cause peptic ulcers.

Symptoms of peptic ulcers

The most common symptom of a peptic ulcer is a burning pain which develops in the abdomen and can spread to the neck. The pain is caused by the ulcer, as well as contact between the ulcer and stomach acid. Some people find that symptoms develop after eating and can come and go quickly or last for several hours. Less common symptoms of peptic ulcers include:

• Heartburn.
• Indigestion.
• Vomiting.
• Loss of appetite.

Should I see a doctor?

If your symptoms suggest the presence of an ulcer it is imperative to see a doctor, especially if you experience any of the following symptoms:

• Vomiting blood.
• Passing very dark stools.
• A sudden and sharp pain in the abdomen that gets worse.

Taking over-the-counter medicine can provide temporary relief, but it is always better to treat the underlying cause of the ulcer.

How are peptic ulcers diagnosed?

Your GP may suspect a peptic ulcer from symptoms alone but this will not be sufficient to reach a firm diagnosis. Further tests that may be needed to diagnose peptic ulcers include an endoscopy and tests for H pylori infection. An endoscopy involves passing a thin, flexible tube fitted with a camera through the mouth and down into the duodenum and stomach, which allows doctors to see the inside of the stomach and duodenum. Your specialist may also take a tissue sample during the endoscopy.

If your GP thinks the ulcer is caused by H pylori infection, they will carry out tests to check for the occurrence of H pylori bacteria, which include blood tests, a stool antigen test and a urea breath test.

Treating peptic ulcers

The treatment plan will come down to the cause of the peptic ulcer. If the ulcer is brought about by an H pylori infection, your doctor will in all probability prescribe a course of antibiotics. This will kill the bacteria and is known as eradication therapy. Antibiotics used to treat peptic ulcers include amoxicillin, metronidazole and clarithromycin.

If non-steroidal anti-inflammatory drugs are the cause and there is no H pylori infection, the usual treatment plan is a course of proton-pump inhibitors. These drugs work by reducing the action of proton pumps, which are responsible for producing stomach acids. Reducing the amount of acid in the stomach helps the ulcers to heal naturally and a course usually lasts between 2 and 3 months.

Medications can take a while to take effect, so your doctor may prescribe antacids or alginates to ease symptoms in the short-term. These medications are also available over-the-counter and help to neutralise stomach acid (antacids) and protect the lining of the stomach (alginates).

Can ulcers come back?

It is infrequent for peptic ulcers to come back after treatment. However, if the ulcer was originally caused by taking non-steroidal anti-inflammatory drugs and you start taking these drugs again, it may return.

Complications of peptic ulcers

In most cases, peptic ulcers can be treated very effectively, but if they are left untreated this can amplify the chance of complications. Possible complications of peptic ulcers include internal bleeding, obstruction of the stomach and perforation.

Internal bleeding: this can cause anaemia and is most common in people over the age of 60. Symptoms of anaemia include tiredness, lethargy and paleness. Internal bleeding can also occur rapidly and this may result in vomiting blood or passing black stools.

Obstruction: peptic ulcers can become inflamed and obstruct the passage of food through the digestive system. Symptoms of obstruction include vomiting regularly, losing weight without any explanation, feeling full even if you haven’t eaten much and constantly feeling bloated.

Perforation: perforation is rare but it can be serious and occurs when the ulcer has eaten through the protective lining of the stomach. If bacteria escape from the stomach it can infect the peritoneum, which is the lining of the abdomen. This is known as peritonitis. Peritonitis is a medical emergency and requires urgent hospital treatment. Symptoms to look out for include fever, severe abdominal pain, rapid heartbeat, chills and feeling thirsty. Some people think that ulcers in the stomach can cause cancer, but this is not the case.