Stomach ulcer – NHS

Stomach ulcers, also known as gastric ulcers, are sores that develop on the lining of the stomach.

You can also get ulcers in part of the intestine just beyond the stomach, which are called duodenal ulcers.

Stomach ulcers and duodenal ulcers (sometimes called peptic ulcers) cause the same symptoms and treatment for both is the same.

Signs and symptoms

The most common symptom of a stomach ulcer is a burning or gnawing pain in the centre of the tummy (abdomen).

But stomach ulcers aren’t always painful and some people may experience other symptoms, such as indigestion, heartburn and acid reflux and feeling sick.

When to seek medical advice

You should visit your GP if you think you may have a stomach ulcer.

Contact your GP or NHS 111 immediately if:

• you are passing dark, sticky, tar-like stools
• you have a sudden, sharp pain in your tummy that gets steadily worse

Go to your nearest accident and emergency (A&E) department or call 999 if:

• you are vomiting blood – the blood can appear bright red or have a dark brown, grainy appearance, similar to coffee grounds

These could be a sign of a serious complication, such as internal bleeding.

Causes of stomach ulcers

Stomach ulcers happen when there’s damage to the layer that protects the stomach lining from the acids in your stomach.

This is usually a result of:

• an infection with Helicobacter pylori (H. pylori) bacteria
• taking anti-inflammatory medicines (NSAIDs), such as ibuprofen or aspirin – particularly if they’re taken for a long time or at high doses

It used to be thought that stress or certain foods might cause stomach ulcers, but there’s little evidence to suggest this is the case.

Stomach ulcers can affect anyone but are more common in people aged 60 or over. Men are more affected than women.

How stomach ulcers are treated

Treatment will depend on what caused the ulcer.

Most people will be prescribed a medication called a proton pump inhibitor (PPI) to reduce the amount of acid in their stomach.

You’ll also need antibiotics if your ulcers were caused by a H. pylori infection.

Stomach ulcers can come back after treatment, although this is less likely to happen if the underlying cause is addressed.

Possible complications

Complications of stomach ulcers are relatively uncommon, but they 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 splitting open (perforation)
• the ulcer blocking the movement of food through the digestive system (gastric obstruction)

Read more about the complications of stomach ulcers.

Page last reviewed: 14 January 2022
Next review due: 14 January 2025

What Does Ulcer Pain Feel Like? Symptoms and Treatment

Pain is the most common symptom of a stomach ulcer. It’s usually a burning pain, typically located in one spot, between your belly button and your breastbone.

A stomach ulcer, also called a peptic ulcer, is a sore that forms in the lining of your stomach or in the first part of your small intestine (duodenum).

Ulcers are most often caused by either a bacterial infection or by taking nonsteroidal anti-inflammatory drugs (NSAIDs). These factors may make the stomach lining more prone to damage from the acids produced during digestion.

Keep reading to learn what ulcer pain feels like, what other symptoms you may experience, and when you should see a doctor.

Pain is the most common symptom of a stomach ulcer. It’s usually a dull or burning pain. People with stomach ulcers also note that their pain does not radiate. Instead, it’s typically located in one spot.

The location of ulcer pain is typically between your belly button and breastbone. The pain may come and go and may feel better for a while if you take an antacid. You may first notice pain between meals or during the night when you’re trying to sleep.

The pain caused by a stomach ulcer may last for just a few minutes or it may go on for hours. It can come and go for days or weeks. The pain may be triggered or made worse by:

• spicy or acidic foods
• stress
• alcohol
• smoking

Besides localized pain, stomach ulcers can cause a number of other symptoms. These may be mild when the ulcer starts and may get worse over time. These symptoms may include:

• feeling full shortly after you start a meal
• feeling uncomfortably full after eating a meal
• nausea
• vomiting
• abdominal bloating
• frequent burping
• acid reflux (GERD)
• frequent diarrhea (if caused by H. pylori bacterial infection)

When to get medical care

It’s a good idea to see your doctor if you have any symptoms of an ulcer. It’s especially important to get medical attention if you notice your symptoms are getting worse. Without proper treatment, stomach ulcers can progress and lead to complications like internal bleeding and gastrointestinal perforation.

Get medical attention as soon as possible if you have:

• blood in your stool (it may look black, maroon, or red)
• blood in your vomit (it may look red or like coffee grounds)
• sudden or severe stomach pain that doesn’t ease or go away
• symptoms of shock

Although there are several home remedies for ulcers, it’s a good idea to see your doctor if you have symptoms of an ulcer.

While you wait to see your doctor, there are some self-care measures you can use to help ease the pain or prevent it from getting worse. This includes:

• Antacids: Antacids, specifically those that contain alginate, help neutralize acid and coat the stomach to relieve pain. These medications can be purchased over the counter at your local pharmacy. You can take them when you have pain or when you might expect to feel pain, like after a meal or while you’re sleeping.
• Over-the-counter (OTC) pain medication: The use of OTC pain medication can be tricky. It’s best not to use ibuprofen, aspirin, or other NSAIDs, as these drugs can cause ulcers or make them worse. Acetaminophen may help, but ask your doctor before taking any pain medication.
• Avoiding spicy or acidic foods: Some types of foods such as spicy foods, coffee, chocolate, alcohol, and acidic foods (citrus fruits, tomatoes), may trigger ulcer pain or make it worse. Try to avoid or limit these foods.

Treatment for a stomach ulcer depends on the root cause. Your doctor will conduct a physical exam and ask you about your health history. Your doctor may also order tests to help diagnose an ulcer. Once a stomach ulcer is diagnosed, your doctor will work with you to create a treatment plan.

Treatments may include:

• Antibiotics: Antibiotics are the treatment of choice when a stomach ulcer is caused by an H. pylori bacterial infection. Amoxicillin, clarithromycin, and metronidazole are often prescribed for this cause.
• Proton pump inhibitors: Proton pump inhibitors (PPI) help with ulcers caused by H. pylori or those caused by NSAIDs. PPIs help heal ulcers by lowering the acid content in your stomach. It may take 4 to 8 weeks for PPIs to fully heal the ulcer.
• h3 receptor blockers: h3-receptor blockers are another medication that can help reduce the amount of acid in your stomach. These medications are available over the counter and by prescription.

Stomach ulcers can be painful. If you have a stomach ulcer, you may feel a burning or sharp pain in one spot, usually between your belly button and your breastbone. You may first notice the pain between meals or at night while trying to sleep.

If you have stomach pain, it’s important that you see your doctor. If a stomach ulcer is left untreated, it may lead to more serious complications. With a proper treatment plan, you can get relief from ulcer pain and, in most cases, the ulcer will heal.

Peptic ulcer of the stomach and / or duodenum – City Hospital No. 40

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What is an ulcer?

Gastric and/or duodenal ulcer is a defect or erosion of its mucous membrane surrounded by an area of ​​inflammation. Occurs as a result of an imbalance between the “protective” factors of the gastric mucosa such as the muco-epithelial barrier, microcirculation, gastric mucus, bicarbonates, hormones (gastrin, secretin, somatostatin), active regeneration, prostaglandins and “aggression” factors – pepsin, hydrochloric acid, Helicobacter pylori.

Incidence rate.

Despite the rapid development of modern medicine and pharmacology, the emergence of the latest medical equipment, a wide range of methods for examining and treating patients, gastric ulcer remains a fairly common disease.

Trusting the statistics, it can be argued that from 6 to 14% of the population in different parts of the world suffer from stomach ulcers.

In Russia, stomach ulcers can be found in approximately 10% of the population. Children account for 1% of the incidence.

Men aged 40-60 are most often affected. Rarely seen in teenagers.

Risk factors

1. Genetic predisposition
2. Helicobacter Pylori
3. Smoking
4. Blood type I antigens
5. Medicines
6. Alcohol abuse
7. Irrational diet (spicy, salty, rough food)
8. Violation of the evacuation of food from the stomach
9. Reduced immunity
10. Nervous and physical strain, frequent stress
11. Meteorological influences (seasonal)
12. Insufficient amount of vitamins in the body

Depending on the location of the lesion, four types of ulcers are distinguished:

• Type I – erosion occurs in the body of the stomach and at the site of its transition to the antrum.
• Type II – association of gastric ulcer with duodenal ulcer.
• III type – lesion of the pyloric part of the stomach.
• Type IV – ulcers that occur on the lesser curvature in the upper part of the stomach, in the area of ​​​​the transition of the esophagus to the stomach. These ulcers are highly prone to malignancy.

What symptoms characterize a stomach ulcer?

Pain in the abdomen (in the epigastric region). By nature, these pains are burning, aching, pressing, squeezing. The pain radiates to the region of the left hypochondrium, lower back on the sides of the spine. Duration from 90 minutes to 3 hours. Characterized by seasonal exacerbation of pain (spring, autumn).

• Nausea
• Heartburn
• Belching (air or food)
• Vomiting (very rare)
• Constipation
• Weight loss
• Disorder of appetite (more often it increases)

Due to unbearable pain in the epigastric region, patients have to take a forced position: squatting, they grab their stomach with both hands or press against the edge of the table, lying in bed, turn on their stomach, etc.

What can be visually detected in a patient with a stomach ulcer?

• White coated tongue
• Excessive sweating, wet palms
• Anterior abdominal wall very sensitive
• Sharp pains on pressure in the epigastric region
• Appearance of tender points on the back in the region of the spine

How to diagnose peptic ulcer?:

• Complete blood count (remains unchanged when the disease is not complicated by other diseases)0037
• Fecal occult blood test – Gregersen test
• Study of the acid-forming function of the stomach (intragastric pH-metry)
• Detection of Helicobacter pylori
• X-ray method: using a contrast agent, this method allows you to detect defects in the gastric mucosa.

FEGDS (fibroesophagogastroduodenoscopy) with a biopsy from the bottom of the ulcer from 4-6 points and a mandatory cytological examination of the biopsy.

Ultrasonography (based on the use of ultrasound at a frequency of approximately 30,000 Hz to image deep body structures) identifies a defect in the stomach wall.

Electrogastroenterography (a method designed to study the motor-evacuation function of the gastrointestinal tract, based on the simultaneous registration of biopotentials from different parts of the gastrointestinal tract).

Possible complications

In most cases, an early diagnosed gastric ulcer can be cured without the development of any complications. But in those cases when the patient begins to neglect his health (the unwillingness of the patient to see a doctor, relying on the fact that the pain will pass by itself; fear of the upcoming diagnosis and procedures; material problems, etc.), he makes his body suffer more and more , which leads to the development of terrible complications:

• Bleeding
• Penetration (penetration of an ulcer into surrounding tissues and organs)
• Perforation (perforation of the ulcer)
• Peritonitis (spread of infection in the abdominal cavity, inflammation of the peritoneum)
• Perivisceritis (formation of adhesions to neighboring organs)
• Ulcer malignancy (malignancy)

Conservative treatment

• Substances that neutralize hydrochloric acid.
• Drugs that suppress the secretion of gastric juice inhibitors of the proton pump.
• Helicobacter pylori preparations
• Drugs that stimulate “protective” factors.
• Sedatives.
• Antispasmodics.

Surgical treatment

Subtotal resection of the stomach, gastrectomy, vagotomy. Apply only according to indications (bleeding from the upper gastrointestinal tract, perforation, penetration, stenosis of the pyloric sphincter, ulcer of endocrine origin – gastrinoma).

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Gastric and duodenal ulcer

Gastric and duodenal ulcer is a wound, ulceration, deep defect in the wall of the duodenum or stomach.

An ulcer can reach deep layers (it can penetrate into the muscle layer and even deeper) of the duodenal and stomach walls, often complicated by bleeding, as well as perforation of the walls of the duodenum and stomach, which is fraught with serious consequences. In most cases, peptic ulcer disease occurs against the background of already existing gastritis (gastroduodenitis), which, like peptic ulcer disease, develops as a result of exposure to the bacterium Helicobacter pylori (helicobacteriosis). The thing is that on the surface of the mucous membrane of the stomach of a person with gastritis, cracks are formed – erosion. And if you do not carry out appropriate treatment, they deepen and get to the muscular layer of the stomach, turning into ulcers.

The main symptom of peptic ulcer is the same as with gastritis – pain in the epigastric region on the left side. With peptic ulcer disease, they differ in frequency – they can fade and reappear (the so-called relapse, or exacerbation of peptic ulcer disease).

In most cases, the appearance of symptoms of peptic ulcer depends on the season: exacerbation most often occurs in spring and autumn. This is its difference from gastritis, which is not seasonal, and the occurrence of discomfort in the stomach is mainly associated with the quality of food and diet.

To find out what the patient is sick with – gastritis or peptic ulcer, as well as to make an accurate diagnosis, FGDS is performed – fibrogastroduodenoscopy.

Causes of peptic ulcer

The main role in the appearance of peptic ulcer is played by Helicobacter pylori bacteria, as well as taking for a long time (30 days) in a standard dosage of non-specific anti-inflammatory drugs (for example, aspirin), cytostatics and corticosteroids (prednisolone).

It is these factors that affect the appearance of damage to the mucous membrane of the duodenum and stomach, reducing protection and increasing the content of hydrochloric acid, which leads to impaired gastric motility.

Main symptoms and signs:

The main signs of the disease are pain and dyspeptic syndrome (sour belching, heartburn, vomiting and nausea).

• Pain appears in the upper part of the abdomen, in the navel, it is bursting, paroxysmal, baking. The patient experiences so-called hunger pains – on an empty stomach, or 2-3 hours after eating (with a duodenal ulcer), although the pain subsides after eating. Patients often complain of pain at night
• Heartburn, which is characterized by a burning sensation behind the sternum, appears after eating – due to the fact that the contents of the stomach are thrown into the esophagus
• Constipation – the majority of patients suffer from them
• Emotional lability, asthenia (insomnia, malaise, weakness) – develop if the illness lasts a long time. At the same time, body weight decreases, which is explained by the restriction in food intake, which the patient sets, fearing the onset of pain
• Vomiting and nausea occur due to an increase in the tone of the vagus nerve, increased hypersecretion of hydrochloric acid and gastric motility. Vomiting appears at the moment when the pain is most pronounced. After vomiting, a feeling of relief comes, the pains noticeably decrease or disappear altogether

When should you rush to the doctor?

The reason for immediately contacting a gastroenterologist at the Medline Medical Center is the appearance of:

• severe weakness
• diarrhea
• frequent vomiting
• the presence of blood impurities in the feces

Peptic ulcer diagnostics

The detection of peptic ulcer in the Medline clinic is based on several basic studies that are aimed at determining the location, size and other characteristics of the ulcer, and also includes tests for intestinal acidity and helicobacteriosis.

A special diagnostic method – FGDS (fibrogastroduodenoscopy) – consists in examining the mucous membrane of the stomach and duodenum by a doctor using a probe that is inserted into the stomach through the esophagus. This method helps to distinguish gastritis (or gastroduodenitis) from an ulcer, which in appearance is usually a round formation of small sizes (up to several centimeters in diameter), along the edges of which there is an elevation indicating intense inflammation (inflammatory shaft). When conducting FGDS, in many cases tissue scrapings are performed from suspicious areas, which are then checked under a microscope for the presence of the causative agent of peptic ulcer – Helicobacter pylori. It is necessary to diagnose helicobacteriosis in order to determine the composition of the treatment and monitor the success of the therapy.

During fibrogastroduodenoscopy, pH measurements are performed – the acidity of the stomach is determined. These data are also needed in order to choose the right course of treatment.

Treatment of peptic ulcer

The main components of the treatment of peptic ulcer:

• Helicobacter pylori treatment
• treatment to reduce stomach acid and promote ulcer healing
• diet

Treatment of peptic ulcer with drugs is carried out according to standard schemes, which include bismuth preparations, antibiotics, proton pump inhibitors (pantoprazole, omeprazole, esomeprazole, rabeprazole).