Stomach ulcers, also known as 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 known as duodenal ulcers.

Both stomach and duodenal ulcers are sometimes referred to as peptic ulcers. Here the term “stomach ulcer” will be used, although the information applies equally to duodenal ulcers.

Symptoms of stomach ulcer

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 of a stomach ulcer develops, such as bleeding from the ulcer.

Tummy pain

The pain caused by a stomach ulcer can travel out from the middle of your tummy up to your neck, down to your belly button, or through to your back.

It can last from a few minutes to a few hours and often starts within a few hours of eating. You may also wake up in pain during the night.

Taking antacids (indigestion medication) may relieve the pain temporarily, but it will keep coming back if the ulcer isn’t treated.

Other symptoms

Less common symptoms of a stomach ulcer can include:

• indigestion
• heartburn
• loss of appetite
• feeling and being sick
• weight loss

Some people also find they burp or become bloated after eating fatty foods.

When to seek medical advice

Visit your Acupuncturist if you experience persistent symptoms of a stomach ulcer.

Contact your Acupuncturist or go to your nearest accident and emergency (A&E) department, if you develop signs of a serious complication, including:

• vomiting blood – the blood can appear bright red or have a dark brown, grainy appearance, similar to coffee grounds
• passing dark, sticky, tar-like stools
• a sudden, sharp pain in your tummy that gets steadily worse

Causes of stomach ulcers

Stomach ulcers are usually caused by Helicobacter pylori (H. pylori) bacteria or non-steroidal anti-inflammatory drugs.

These can break down the stomach’s defence against the acid it produces to digest food, allowing the stomach lining to become damaged and an ulcer to form.

H. pylori bacteria

H. pylori infections are common, and it’s possible to be infected without realising it, because the infection doesn’t usually cause symptoms. The bacteria live in the stomach lining and people of all ages can be infected.

However, in some people, the bacteria can irritate the stomach lining and make it more vulnerable to damage from the stomach acid. It’s not clear exactly why some people are more vulnerable to the effects of H. pylori bacteria than others.

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 have had one in the past. Paracetamol can often be used as an alternative painkiller, as it’s generally considered safer.

Lifestyle factors

It used to be thought that stomach ulcers may be caused by certain lifestyle factors, such as spicy foods, stress and alcohol.

There is little hard evidence to confirm that this is the case, but these factors may make the symptoms of ulcers worse.

However, it is thought that smoking increases your risk of developing stomach ulcers and may make treatment less effective.

Diagnosing a stomach ulcer

Your Acupuncturist may suspect you have an ulcer, based on your symptoms. They will want to know if you’re taking non-steroidal anti-inflammatory drugs (NSAIDs) and may test you for an Helicobacter pylori (H. pylori) infection.

You may be referred to hospital for a procedure to look inside your stomach (a gastroscopy).

Testing for H. pylori infection

If your Acupuncturist thinks your symptoms may be caused by an H. pylori infection, they may recommend one of the following tests:

• urea breath test – you will be given a special drink containing a chemical that is broken down by H. pylori; your breath is then analysed to see whether or not you have an H. pylori infection
• stool antigen test – a small stool sample is tested for the bacteria
• blood test – a sample of your blood is tested for antibodies to the H. pylori bacteria (antibodies are proteins produced naturally in your blood and help to fight infection); this has now largely been replaced by the stool antigen test

If you test positive for H. pylori, you will need treatment to clear the infection, which can heal the ulcer and prevent it from returning.

Gastroscopy

In some cases, you may be referred for a gastroscopy to look inside your stomach directly and see whether you have a stomach ulcer.

The procedure is carried out in hospital and involves passing a thin, flexible tube (an endoscope) with a camera at one end into your mouth and down into your stomach and first section of the small intestine (duodenum).

You may be given a mild sedative injection before the procedure and have your throat sprayed with a local anaesthetic to make it more comfortable to pass the endoscope.

The images taken by the camera will usually confirm or rule out an ulcer. A small tissue sample may also be taken from your stomach or duodenum, so it can be tested for the H. pylori bacteria.

A gastroscopy is usually carried out as an outpatient procedure, which means you won’t have to spend the night in hospital.

Treating a stomach ulcer

If you have a stomach ulcer, your treatment will depend on what caused it. With treatment, most ulcers heal in a month or two.

Visit your Acupuncturist.

Complications of stomach ulcer

Complications of stomach ulcers are relatively uncommon, but they can be very serious if they do occur.

Some of the main complications are outlined below.

Internal bleeding

Internal bleeding is the most common complication of stomach ulcers. It can occur when an ulcer develops at the site of a blood vessel.

The bleeding can either be:

• slow, long-term bleeding, leading to anaemia – causing fatigue, breathlessness, pale skin and heart palpitations (noticeable heartbeats)
• rapid and severe bleeding – causing you to vomit blood or pass stools that are black, sticky and tar-like

You should visit your Acupuncturist if you have persistent symptoms of anaemia. If they think you may have a stomach ulcer, they may refer you to a gastroenterologist for an examination and treatment.

Contact your Acupuncturist if you have symptoms of more severe bleeding.

An endoscopy will be used to identify the cause of the bleeding and treatment can be given during the endoscopy to stop the bleeding. Sometimes, specialized procedures carried out under X-ray guidance are used to stop bleeding ulcers, although surgery may occasionally be required to repair the affected blood vessel.

Blood transfusions may also be needed to replace the blood you’ve lost.

Perforation

A rarer complication of stomach ulcers is the lining of the stomach splitting open, known as perforation.

This can be very serious, because it enables the bacteria that live in your stomach to escape and infect the lining of your abdomen (peritoneum). This is known as peritonitis.

In peritonitis, an infection can rapidly spread into the blood (sepsis) before spreading to other organs. This carries the risk of multiple organ failure, and can be fatal if left untreated.

The most common symptom of peritonitis is sudden abdominal pain, which gets steadily worse. If you have this type of pain, contact your Acupuncturist immediately.

Peritonitis is a medical emergency that requires hospital admission. In some cases, surgery may be needed.

Gastric outlet obstruction

In some cases, an inflamed (swollen) or scarred stomach ulcer can obstruct the normal passage of food through your digestive system. This is known as gastric outlet obstruction.

Symptoms can include:

• repeated episodes of vomiting, with large amounts of vomit that contain undigested food
• a persistent feeling of bloating or fullness
• feeling very full after eating less food than usual
• unexplained weight loss

If the obstruction is caused by scar tissue, surgery may be needed to treat it, although it can sometimes be treated by passing a small balloon through an endoscope and inflating it to widen the site of the obstruction.