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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.

your symptoms persist
you’re vomiting blood – the blood can appear bright red or have a dark brown, grainy appearance like coffee grounds
you’re 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 they’re taken for a long time or at high doses

There’s little evidence that stress or certain foods causes stomach ulcers.

Treating stomach ulcers

You’ll 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.
You’ll 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.

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

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 aren’t 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 isn’t treated.

Less common symptoms

Less common symptoms of a stomach ulcer include:

indigestion
heartburn
loss of appetite
feeling and being sick
weight loss

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 stomach’s 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. It’s possible to be infected without realising it because the infection doesn’t usually cause symptoms. People of all ages can be infected. It’s 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 there’s 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 you’ve had one in the past. Paracetamol is a safer painkiller to use.

Lifestyle factors

There’s 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

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