The stomach produces a strong acid to help digest food and protect against microbes. To protect the body's tissues from this acid, it also secretes a thick layer of mucus.
If the mucus layer is worn away and stops functioning effectively, the acid can damage the stomach tissue, causing an ulcer.
An estimated 1 in every 10 people in Western countries will have an ulcer in the stomach or small intestine at some point in their lives.
Stomach ulcers are relatively easy to cure, but if left untreated they can cause significant problems.
Fast facts on stomach ulcers
Here are some key points about stomach ulcers. More detail and supporting information is in the main article.
- Stomach ulcers are common in the West and easy to treat, but, if left, can become serious
- The most common causes are bacteria and use of nonsteroidal anti-inflammatory drugs
- The classic symptom of a stomach ulcer is indigestion
- Treatment for stomach ulcers normally focuses on removing the cause
Causes of stomach ulcers
A class of painkillers known as NSAIDs can increase the risk of stomach ulcers.
The two main causes of ulcers of the stomach and small intestine are:
- Helicobacter pylori bacteria
- A class of painkillers called nonsteroidal anti-inflammatories, (NSAIDs)
Less common causes of stomach ulcers include:
- Excess stomach acidity (hyperacidity) - this can occur for a range of reasons, including genetics, smoking, stress, and some foods
- Zollinger-Ellison - a disease that causes an excess of stomach acid to be produced (rare)
Certain behaviors and factors increase the chances of developing a stomach ulcer; these include:
- Frequent steroid usage.
- Overproducing calcium - hypercalcemia.
- Consuming alcohol frequently.
- Age - they are more common in individuals over 50. People of any age can develop a stomach ulcer, but they are much less common in children. The risk in children is higher if their parents smoke.
NSAID drugs and stomach ulcers
A group of painkillers known as NSAIDs carry a risk of stomach ulcers. The two best-known NSAIDs are aspirin and ibuprofen.
The risk of ulcers increases if the drugs are taken in high doses, or regularly for a long time.
Stronger NSAIDs needed on prescription are riskier for stomach ulcers than those that can be bought over the counter.
People should always check labels and talk to a pharmacist or a doctor about any concerns with using painkillers. They may recommend an alternative such as acetaminophen.
Stomach ulcer symptoms
Pain is the main symptom of a stomach ulcer, either around the stomach or slightly higher up.
The classic symptom of a stomach ulcer is indigestion, also called dyspepsia. Indigestion causes pain or discomfort in the stomach area. This symptom can be mistaken for heartburn, which can occur at the same time.
Heartburn can be caused by acid reflux or gastroesophageal reflux disease (GERD). It occurs slightly higher up from the stomach and is felt in the lower part of the chest.
It is worth noting that not all stomach ulcers cause indigestion.
Stomach ulcer symptoms tend to be more distinct than heartburn, but symptoms can still be vague. An ulcer tends to:
- Produce a burning or dull pain in the stomach area
- This pain is sometimes described as a "biting" or "gnawing" pain
- Some people describe a hungry sensation
- Weight loss
- Nausea and/or vomiting
- Not eating because of pain
- Pain may be relieved by eating, drinking, or taking antacids
Ulcers in the stomach tend to show slightly different signs and symptoms than those in the small intestine:
- Stomach ulcers tend to show less clear symptoms, with the pain being less consistent. Sometimes the pain is worse after eating food.
- Small intestine ulcers are more likely to produce a consistent pain. The pain is sometimes worse in the middle of the night but better first thing in the morning. When the pain appears later in the day, eating food tends to reduce it.
Some stomach ulcers go unnoticed and show no typical indigestion-type pains. These ulcers are less common and tend to be diagnosed after the ulcer has started bleeding. Some ulcers can become a hole in the stomach wall; this is known as perforation and is a serious condition.
Stomach ulcer symptoms often change over time and can be difficult to spot.
When to see a doctor about stomach ulcer
Anyone who thinks they may have an ulcer in their stomach should consult their doctor. Any stomach symptoms that last for more than a few days or keep happening need evaluation and treatment.
A slow-bleeding ulcer can be signaled by symptoms of anemia, such as being tired and breathless. More serious bleeding is an urgent medical problem, and can be signaled if blood is vomited up, or stools are black and sticky.
Perforation - a hole in the stomach - is also an emergency. Without quick treatment, the wall of the stomach can get infected. Sudden belly pain that gets worse can signal perforation, and any signs of being very unwell with infection need treatment as soon as possible.
Diagnosis of stomach ulcers
Stomach ulcers are often treated by removing the cause of the problem.
Doctors follow the symptoms of a stomach ulcer by asking questions about how the pain feels, where and when it happens, and how frequent and long-lasting it has been.
This process helps to narrow down whether there is a stomach ulcer or not. Your doctor may also ask for a stool test or a breath test to find out whether the stomach ulcer is from Helicobacter pylori bacteria.
If there are more serious symptoms such as bleeding the doctor may require further testing, which may include:
- Endoscopy - a camera to look at the gut lining; a biopsy (tissue sample) may be taken
- Barium enema - a thick liquid that allows X-rays to be taken of the gut
Treating stomach ulcers
If the doctor thinks there is a stomach ulcer, they may try to remove the cause by:
- If the cause is thought to be NSAIDs, they may change the type of painkiller being taken
- Trying the "test-and-treat" approach if the cause is thought to be H. pylori bacteria
Once the cause has been removed, the symptoms of stomach ulcers can be treated by protecting the ulcer from acid while it heals. Drugs a doctor could prescribe include:
- A proton pump inhibitor (PPI) - blocks acid producing cells
- H2-receptor antagonist - prevents stomach from producing excess acid
- OTC antacids or alginate
- Drugs that protect the stomach lining - Pepto-Bismol, for instance
Symptoms often subside quickly following treatment. However, the treatment should be continued, especially if the ulcer is due to an H. pylori infection. It is also important to avoid drinking alcohol, smoking tobacco, and any trigger foods during treatment.
In certain cases, surgery may be an option. For instance, if the ulcer continues to return, won't heal, bleeds, or prevents food from leaving the stomach.
Surgery can include:
- Removing the ulcer
- Tying off bleeding blood vessels
- Sewing tissue from another site onto the ulcer
- Cutting the nerve that controls stomach acid production
Complications from stomach ulcers such as bleeding or perforation are rare. Either of these complications requires urgent medical attention.