Peptic ulcers - the gut wrenching facts

Peptic ulcers are a condition that will affect around 10% of people at some stage in their life, more often than not when they are elderly, but it is possible for anyone of any age to be affected. Most peptic ulcers cause no more than abdominal discomfort, pain and indigestion, resolving within a couple of months of starting treatment. However, in certain cases they can have grave consequences, which is why it is important to know the signs and when to visit your GP. (1)

What are peptic ulcers?

‘Peptic ulcers’ is a collective term for gastric (stomach) and duodenal (upper small intestinal) ulcers. They are sores that occur on the lining of these areas, caused by stomach acid coming into contact with the lining. Usually, the lining is shielded from the acid by mucus, but certain factors can deplete this mucus layer. One is Helicobacter pylori, a type of bacteria which lives in the stomach lining of around half of all people. Some of these people don’t know that they’re infected because the bacteria cause no problems. For others, ulceration develops because H. pylori degrades the protective mucus, leaving the lining exposed. Another factor which can lead to peptic ulcers is taking a type of medicine called non-steroidal anti-inflammatory drugs (NSAIDs), which include ibuprofen, aspirin, naproxen, diclofenac and etoricoxib amongst others. It is thought that this happens because the same pain and inflammation-causing compounds which NSAIDs reduce levels of are also responsible for protecting the lining of the stomach and upper section of the small intestine. Taking high doses of NSAIDs, or taking them for a prolonged period of time, increases the chances of developing peptic ulcers in this way. Smoking can also make peptic ulceration more likely. (1, 2, 3)

How do I know if I have a peptic ulcer?

Generally, a peptic ulcer will cause a burning or gnawing-type pain that can be pinpointed to the middle of the abdomen. It may sometimes spread to other areas such as the back, neck or belly button. This pain usually occurs on an empty stomach and may be temporarily relieved by eating. Indigestion, heartburn, reduced appetite, nausea and vomiting can also occur. (1, 4)

How are peptic ulcers treated?

The first-line treatment for peptic ulcers is a drug known as a proton pump inhibitor (PPI). They work by inactivating a channel called the proton pump, which is found in the acid-producing cells of the stomach. This reduces the level of stomach acid, allowing the ulcer to heal. Commonly prescribed PPIs include omeprazole, esomeprazole, lansoprazole and pantoprazole. (5)

If the ulcer is found to have been caused by H. pylori, a course of antibiotics will need to be taken alongside a PPI, usually clarithromycin with amoxicillin or metronidazole. If successful, the H. pylori are eradicated after 7 days of treatment. (5)

If PPIs are unsuitable, a type of drug that works in a different way to reduce stomach acid may be given, namely an H2-receptor antagonist. These drugs work by binding to the H2-receptor in the stomach which also plays a part in stomach acid production. The most commonly used H2-receptor antagonist is ranitidine. (5)

When do I need to seek medical help?

If you find you are frequently experiencing the symptoms listed above, visit your GP who can assess your condition and get you started on the necessary treatment.

If you vomit blood (this can appear fresh in some cases, but dark brown and grainy in others), pass black tarry stools, or experience a piercing abdominal pain that progressively intensifies, you need to seek urgent medical help as you may have a bleeding ulcer or peritonitis, an abdominal infection caused by a ruptured lining. Make an emergency appointment with your GP or ring NHS Direct on 111. If this is not possible, visit A&E. (6)

Is there anything I can do to ease the symptoms?

Peptic ulcers take weeks to heal, so in the meantime, you can ease pain and discomfort by avoiding alcoholic drinks, smoking, and spicy, fatty or acidic foods. You may find taking an over the counter antacid suspension such as Gaviscon after meals and at bedtime helps. Also, make sure you avoid taking NSAIDs for pain relief, instead opting for paracetamol. (5)

References

For further information, click here or ask your pharmacist.

1. NHS Choices. Overview [cited 19 January 2018]. Available at: https://www.nhs.uk/conditions/stomach-ulcer/

2. NHS Choices. Causes [cited 19 January 2018]. Available at: https://www.nhs.uk/conditions/stomach-ulcer/causes/

3. UpToDate. NSAIDs (including aspirin): Pathogenesis of gastroduodenal toxicity [cited 19 January 2018]. Available at: https://www.uptodate.com/contents/nsaids-including-aspirin-pathogenesis-of-gastroduodenal-toxicity

4. NHS Choices. Symptoms [cited 19 January 2018]. Available at: https://www.nhs.uk/conditions/stomach-ulcer/symptoms/

5. NHS Choices. Treatment [cited 19 January 2018]. Available at: https://www.nhs.uk/conditions/stomach-ulcer/treatment/

6. NHS Choices. Complications [cited 19 January 2018]. Available at: https://www.nhs.uk/conditions/stomach-ulcer/complications/

   Author: Gabby Gallagher MPharm

   Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 22/01/18