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
‘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,
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
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.
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
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.
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)
For further information, click here or ask your
NHS Choices. Overview [cited 19 January 2018].
Available at: https://www.nhs.uk/conditions/stomach-ulcer/
NHS Choices. Causes [cited 19 January 2018].
Available at: https://www.nhs.uk/conditions/stomach-ulcer/causes/
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
NHS Choices. Symptoms [cited 19 January 2018].
Available at: https://www.nhs.uk/conditions/stomach-ulcer/symptoms/
NHS Choices. Treatment [cited 19 January 2018].
Available at: https://www.nhs.uk/conditions/stomach-ulcer/treatment/
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