Peptic ulcers and H. pylori: symptoms, causes and treatment

A peptic ulcer is a real sore that needs proper diagnosis and care. This article explains what peptic ulcers are, why they form, how doctors find them and what treatment involves, using the NHS, the US National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and MedlinePlus.

1. Introduction

A peptic ulcer is a sore in the lining of the stomach or the duodenum, which is the upper part of the small intestine ^{[2, 3]}. A sore in the stomach is also called a stomach or gastric ulcer. The NHS says ulcers can be serious, but most people recover with treatment ^[1].

2. Causes and risk factors

The most common causes are ^{[1, 2, 3]}:

• Infection with Helicobacter pylori, usually called H. pylori, a type of bacteria that lives in the stomach lining
• Regular use of non-steroidal anti-inflammatory drugs (NSAIDs), a group of painkillers that includes aspirin and ibuprofen

The NHS adds that smoking raises the risk and that risk increases with age ^[1]. MedlinePlus says stress and spicy foods do not cause ulcers, but they can make them worse ^[3].

3. Signs and symptoms

The most common symptom is burning pain in the upper tummy. It often starts between meals or during the night and may briefly ease after eating or taking an antacid. The pain can last from minutes to hours and may come and go over days or weeks ^{[1, 3]}.

Other symptoms include indigestion, heartburn, bloating, nausea or vomiting ^[1]. NIDDK lists feeling full too soon during a meal, feeling too full after a meal, and belching ^[2].

4. Diagnosis and tests

A doctor will ask about your symptoms and medicines and may examine your tummy ^{[1, 2]}. Tests for H. pylori include a breath test, a stool sample and a blood test ^{[1, 3]}.

Your doctor may also refer you for a gastroscopy, also called upper endoscopy. A thin, flexible tube with a camera is passed through the mouth into the stomach so that the doctor can look at it ^[1]. An upper endoscopy and an X-ray series of the upper digestive tract is another option ^{[1, 2, 3]}.

5. Treatment and management

Treatment depends on the cause ^{[1, 2]}. NIDDK explains that medicines are used to heal the ulcer and the underlying cause is treated. If H. pylori is found, it is treated with medicines, and if painkillers are the cause, the doctor may change your medicines ^[2].

The NHS describes the following approach ^[1]:

• Antibiotics to clear H. pylori infection
• Medicines that reduce stomach acid
• Treatment usually lasts from 1 week to 2 months, and follow-up tests may be needed
• If symptoms return, see a doctor, because a different medicine or a longer course may be needed
• A doctor may also suggest changing medicines that make symptoms worse, and getting help for stress, anxiety or low mood

MedlinePlus explains that the stomach acids that help digest food can damage the wall of the stomach or duodenum ^[3]. It says antacids and milk cannot heal peptic ulcers, that not smoking and avoiding alcohol can help, and that surgery may be needed if an ulcer does not heal. Untreated ulcers get worse ^[3].

6. Prevention and self-care

The NHS suggests these steps ^[1]:

• Eat smaller meals and finish your evening meal 3 to 4 hours before bed
• Keep a healthy weight and manage stress
• Do not take anti-inflammatory painkillers such as ibuprofen without speaking to a doctor first
• Avoid foods or drinks that seem to trigger your symptoms, such as fatty or spicy foods, coffee and chocolate
• Stop smoking and drink less alcohol
• The NHS Better Health service offers free support for weight loss, activity, quitting smoking and drinking less

NIDDK notes that researchers have not found that diet plays an important role, and doctors do not recommend a special diet ^[2]. So the food advice above is about easing your own symptoms.

7. Complications

If an ulcer is untreated it can cause serious problems ^{[1, 2]}:

• Bleeding from the stomach or intestine, which can lead to iron-deficiency anaemia, a shortage of red blood cells
• A hole through the stomach wall, called perforation, which can cause peritonitis, a serious infection inside the tummy
• Blockage of the stomach or the duodenum

The NHS also notes that untreated H. pylori infection raises the risk of stomach cancer over time ^[1].

8. When to see a doctor

The NHS advises seeing a doctor if indigestion does not improve with treatment or tummy pain keeps coming back ^[1]. Seek urgent medical advice for worsening or constant tummy pain, loss of appetite, feeling full after eating very little, weight loss without trying, a lump in the tummy, painful or difficult swallowing, persistent vomiting, or constant tiredness ^[1].

Go to emergency care straight away if you ^[1]:

• Vomit bright red blood, or vomit that looks like coffee grounds
• Pass blood in your poo, or black, sticky, very smelly poo
• Have severe tummy pain
• Have sudden chest pain

The NHS advises not to drive yourself, and to bring a list of your medicines. In an emergency, call your local emergency number (112 in India, 911 in the United States).

9. Conclusion

Peptic ulcers are sores in the lining of the stomach or duodenum, most often caused by H. pylori infection or regular use of anti-inflammatory painkillers. They are usually found by simple tests or a camera examination and treated according to cause with acid-lowering medicines and, for infection, antibiotics. Report symptoms early and get urgent help for signs of bleeding.