The human body is very delicate and the slightest misadventure in your feeding pattern or harmful exposure to harmful conditions, and even accidents can cause damage and erosion of the linning of the gut.
The stomach is the most exposed part of your digestive system, any food you eat or ingest must be processed in the stomach for digestion and ultimate absorption in the appropriate areas of the gut.
It is therefore filled with various digestive enzymes and juices to aid this process.
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.
A number of symptoms are associated with stomach ulcers. The severity of the symptoms depends on the severity of the ulcer. The most common symptom is a burning sensation or pain in the middle of your abdomen between your chest and belly button. Typically, the pain will be more intense when your stomach is empty, and it can last for a few minutes to several hours.
The most common peptic ulcer symptom is burning stomach pain. Stomach acid makes the pain worse, as does having an empty stomach. The pain can often be relieved by eating certain foods that buffer stomach acid or by taking an acid-reducing medication, but then it may come back. The pain may be worse between meals and at night. Nearly three-quarters of people with peptic ulcers don’t have symptoms.
Stomach ulcers are common. Other common signs and symptoms of ulcers include:
• Burning stomach pain
• Feeling of fullness, bloating or belching
• Fatty food intolerance
• dull pain in the stomach
• weight loss
• not wanting to eat because of pain
• nausea or vomiting
• bloating
• burping or acid reflux
• heartburn (burning sensation in the chest)
• pain that may improve when you eat, drink, or take antacids
• anemia (symptoms can include tiredness, shortness of breath, or paler skin)
• dark, tarry stools
• vomit that’s bloody or looks like coffee grounds
When to seek medical help
It is important you see the doctor if you have any of the symptoms above and if over-the-counter antacids and acid blockers relieve your pain but the pain returns.
• 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
Peptic ulcers occur when acid in the digestive tract eats away at the inner surface of the stomach or small intestine. The acid can create a painful open sore that may bleed.
Your digestive tract is coated with a mucous layer that normally protects against acid. But if the amount of acid is increased or the amount of mucus is decreased, you could develop an ulcer
It could also occur when the layer that protects the stomach lining from stomach acid breaks down, which allows the stomach lining to become damaged.
• an infection with Helicobacter pylori (H. pylori) bacteria
• taking non-steroidal anti-inflammatory drugs (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 are usually caused by Helicobacter pylori (H. pylori) bacteria or non-steroidal anti-inflammatory drugs (NSAIDs).
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.
• A bacterium. Helicobacter pylori bacteria commonly live in the mucous layer that covers and protects tissues that line the stomach and small intestine. Often, the H. pylori bacterium causes no problems, but it can cause inflammation of the stomach’s inner layer, producing an ulcer. It’s not clear how H. pylori infection spreads. It may be transmitted from person to person by close contact, such as kissing. People may also contract H. pylori through food and water.
• Regular use of certain pain relievers. Taking aspirin, as well as certain over-the-counter and prescription pain medications called nonsteroidal anti-inflammatory drugs (NSAIDs) can irritate or inflame the lining of your stomach and small intestine. These medications include ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve, Anaprox, others), but not acetaminophen (Tylenol).
 Peptic ulcers are more common in older adults who take these pain medications frequently or in people who take these medications for osteoarthritis.
• Other medications. Taking certain other medications along with NSAIDs, such as steroids, anticoagulants, low-dose aspirin, selective serotonin reuptake inhibitors (SSRIs), alendronate (Fosamax) and risedronate (Actonel), can greatly increase the chance of developing ulcers.
• 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.
Diagnosis
Your doctor 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 doctor thinks your symptoms may be caused by an H. pylori infection, they may recommend one of the following tests:
1. 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
2. stool antigen test – a small stool sample is tested for the bacteria
3. 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.
4. 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.
5. Upper gastrointestinal series. Sometimes called a barium swallow, this series of X-rays of your upper digestive system creates images of your esophagus, stomach and small intestine. During the X-ray, you swallow a white liquid (containing barium) that coats your digestive tract and makes an ulcer more visible.
Treatments
If you have a stomach ulcer, your treatment will depend on what caused it. With treatment, most ulcers heal in a month or two.
If your stomach ulcer is caused by an Helicobacter pylori (H. pylori) bacterial infection, a course of antibiotics and a medication called a proton pump inhibitor (PPI) is recommended.
This is also recommended if it’s thought your stomach ulcer is caused by a combination of an H. pylori infection and non-steroidal anti-inflammatory drugs (NSAIDs).
If your stomach ulcer is just caused by taking NSAIDs, a course of PPI medication is recommended. Your use of NSAIDs will also be reviewed, and taking an alternative painkiller may be advised.
An alternative type of medication, known as H2-receptor antagonists, is occasionally used instead of PPIs, and sometimes you may be given additional medication called antacids to relieve your symptoms in the short term.
You may have a repeat gastroscopy after four to six weeks to check that the ulcer has healed.
There aren’t any special lifestyle measures you need to take during treatment, but avoiding stress, alcohol, spicy foods and smoking may reduce your symptoms while your ulcer heals.
Treatment for peptic ulcers depends on the cause. Usually treatment will involve killing the H. pylori bacterium, if present, eliminating or reducing use of aspirin and similar pain medications, if possible, and helping your ulcer to heal with medication.
Medications can include
• Antibiotic medications to kill H. pylori. If H. pylori is found in your digestive tract, your doctor may recommend a combination of antibiotics to kill the bacterium. These may include amoxicillin (Amoxil), clarithromycin (Biaxin), metronidazole (Flagyl), tinidazole (Tindamax), tetracycline (Tetracycline HCL) and levofloxacin (Levaquin).
The antibiotics used will be determined by where you live and current antibiotic resistance rates. You’ll likely need to take antibiotics for two weeks, as well as additional medications to reduce stomach acid, including a proton pump inhibitor and possibly bismuth subsalicylate (Pepto-Bismol).
• Medications that block acid production and promote healing.
• Proton pump inhibitors — also called PPIs — reduce stomach acid by blocking the action of the parts of cells that produce acid. These drugs include the prescription and over-the-counter medications omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex), esomeprazole (Nexium) and pantoprazole (Protonix).
 Long-term use of proton pump inhibitors, particularly at high doses, may increase your risk of hip, wrist and spine fracture. Ask your doctor whether a calcium supplement may reduce this risk.
• Medications to reduce acid production. Acid blockers — also called histamine (H-2) blockers — reduce the amount of stomach acid released into your digestive tract, which relieves ulcer pain and encourages healing.
  Available by prescription or over-the-counter, acid blockers include the medications ranitidine (Zantac), famotidine (Pepcid), cimetidine (Tagamet HB) and nizatidine (Axid AR).
• Antacids that neutralize stomach acid. Your doctor may include an antacid in your drug regimen. Antacids neutralize existing stomach acid and can provide rapid pain relief. Side effects can include constipation or diarrhea, depending on the main ingredients.
 Antacids can provide symptom relief, but generally aren’t used to heal your ulcer.
Medications that protect the lining of your stomach and small intestine. In some cases, your doctor may prescribe medications called cytoprotective agents that help protect the tissues that line your stomach and small intestine.
Risk factors
In addition to taking certain pain medications, including aspirin, you may have an increased risk of peptic ulcers if you:
• Smoke. Smoking may increase the risk of peptic ulcers in people who are infected with H. pylori.
• Drink alcohol. Alcohol can irritate and erode the mucous lining of your stomach, and it increases the amount of stomach acid that’s produced.
• Have untreated stress.
• Eat spicy foods.
Alone, these factors do not cause ulcers, but they can make them worse and more difficult to heal.
Complications
Left untreated, peptic ulcers can result in:
• Internal bleeding. Bleeding can occur as slow blood loss that leads to anemia or as severe blood loss that may require hospitalization or a blood transfusion. Severe blood loss may cause black or bloody vomit or black or bloody stools.
• Infection. Peptic ulcers can eat a hole through (perforate) the wall of your stomach or small intestine, putting you at risk of serious infection of your abdominal cavity (peritonitis).
• Obstruction. Peptic ulcers can lead to swelling, inflammation or scarring that may block passage of food through the digestive tract. A blockage may make you become full easily, vomit and lose weight.
