Peptic ulcer

Also called Stomach ulcer, Duodenal ulcer, Helicobacter pylori

Not caused by stress or spicy food. Two things cause almost all of them, and one is a bacterium that can be cured in a week.

What it is

A break in the lining of the stomach or the first part of the small intestine.

For most of the twentieth century these were blamed on stress and personality, and treated with milk and rest. They are caused by two things: infection with the bacterium Helicobacter pylori, and anti-inflammatory painkillers such as ibuprofen, naproxen and aspirin. Between them those account for the overwhelming majority.

That matters because both are addressable. H. pylori is cured by a week or two of two antibiotics and an acid-suppressing drug, and testing for it is a simple breath or stool test. Anti-inflammatories can often be stopped, reduced, or covered with a protective drug.

The complications are what make this more than an inconvenience: bleeding, which can be sudden and severe, and perforation, which is a surgical emergency.

Long-term acid suppression without ever testing for H. pylori is one of the commonest patterns in primary care, and it treats the symptom while leaving the cause in place.

Signs you might notice

Burning or gnawing pain in the upper abdomen, often at night or when the stomach is empty, sometimes eased by food or antacids.

Indigestion, bloating, feeling sick, or feeling full quickly.

999 or A and E now: vomiting blood, or vomit that looks like coffee grounds; black tarry stools; sudden severe abdominal pain with a rigid, tender abdomen; fainting or collapse.

Urgent GP or two-week referral: unexplained weight loss, difficulty swallowing, persistent vomiting, or a new indigestion in anybody over 55 that will not settle. These are the features that could mean stomach or oesophageal cancer.

Anaemia found on a blood test with no other explanation can be a slow bleed from an ulcer nobody knew about.

How it can affect day-to-day life

The group most at risk of a bleed is the least likely to have symptoms first: older people taking anti-inflammatories for osteoarthritis, often alongside aspirin or an anticoagulant, whose ulcer announces itself as a collapse.

Anti-inflammatory gels are absorbed far less and are a genuine alternative for many joint problems.

The eradication treatment is a lot of tablets for a week or two and the side effects put people off finishing it. Not finishing it is how it fails, and how resistance builds.

Confirming the infection has actually gone, with a repeat test at least four weeks after treatment, is often skipped.

Supporting someone well

Ask to be tested for H. pylori rather than starting another course of acid suppression. It is a simple test and it is frequently not done.

Review every anti-inflammatory the person takes, including the ones bought over the counter and the ones prescribed years ago.

Anybody on long-term anti-inflammatories, especially over 65 or alongside aspirin, steroids or an anticoagulant, should be on a stomach-protecting drug. Ask whether they are.

Finish the eradication course, all of it, and ask about the confirmatory test afterwards.

Learn the emergency signs. Black tarry stools and coffee-ground vomit are a 999 call, not a morning appointment.

Stopping smoking speeds healing and reduces recurrence. See smoking.

Where to get help

A GP practice for testing, treatment and a medication review.

999 or A and E for bleeding, black stools, or sudden severe abdominal pain.

Guts UK publish clear patient information on H. pylori and ulcers.