Stomach Ulcers (Peptic Ulcers): Symptoms, Causes, and Treatment in the UK

A stomach ulcer, also known as a gastric ulcer, is an open sore that develops on the lining of the stomach. They fall under the umbrella term 'peptic ulcers,' which also includes duodenal ulcers—sores that form in the first part of the small intestine (the duodenum). In the UK, stomach ulcers are a relatively common digestive issue, affecting roughly 1 in 10 people at some point in their lives.

For a long time, it was mistakenly believed that stress or spicy food caused ulcers directly. While these factors can certainly aggravate existing symptoms, we now know that ulcers are primarily caused by physical factors that weaken the protective mucous layer of the stomach, allowing digestive juices to damage the sensitive lining beneath.

The most distinctive symptom of a stomach ulcer is a burning or gnawing pain in the centre of the abdomen (tummy). However, not all ulcers cause pain; some are only discovered when they lead to complications. When pain does occur, it typically follows these patterns:

• Timing: The ache often occurs between meals or during the night when the stomach is empty.
• Relief: Eating food or taking antacids may temporarily soothe the discomfort.
• Duration: The pain may last for minutes or hours and can come and go over several weeks.

Other symptoms include indigestion, heartburn, loss of appetite, and feeling abnormally full after eating small amounts. Some people also experience nausea or mild bloating after meals.

According to NHS and NICE guidelines, there are two primary culprits responsible for the vast majority of peptic ulcers:

1. Helicobacter pylori (H. pylori)

This is a common type of bacteria that infects the stomach lining. For many people, H. pylori causes no issues, but in others, it triggers inflammation and breaks down the stomach's protective coating, leading to an ulcer.

2. Non-steroidal anti-inflammatory drugs (NSAIDs)

Regular or long-term use of medications such as ibuprofen, aspirin, or naproxen can disrupt the stomach's ability to protect itself from acid. This is particularly common in older adults or those managing chronic pain conditions.

While lifestyle factors like smoking and excessive alcohol consumption do not cause ulcers directly, they can significantly increase your risk of developing one and slow down the healing process once an ulcer has formed.

If you suspect you have an ulcer, a GP will typically start by reviewing your medical history and medication use. Diagnosis often involves checking for H. pylori through one of three methods:

• Urea Breath Test: You drink a liquid containing a special substance and then breathe into a bag.
• Stool Antigen Test: A small stool sample is tested for the presence of the bacteria.
• Blood Test: To look for antibodies against H. pylori (though this is less common as it cannot distinguish between past and current infections).

If your symptoms are persistent or you fall into a higher-risk age bracket, you may be referred for a gastroscopy (endoscopy). This involves a thin, flexible tube with a camera being passed down your throat to allow a doctor to look directly at the stomach lining.

Most stomach ulcers are highly treatable and will heal within one to two months. The treatment plan depends on the underlying cause:

Antibiotics

If an H. pylori infection is found, you will be prescribed a 'triple therapy' course. This usually consists of two different antibiotics and an acid-suppressing medication taken for one week to eradicate the bacteria.

Proton Pump Inhibitors (PPIs)

PPIs, such as omeprazole or lansoprazole, work by reducing the amount of acid your stomach produces. This allows the ulcer to heal naturally without being further irritated by gastric juices. A course typically lasts 4 to 8 weeks.

Lifestyle Adjustments

To support healing, it is recommended to eat smaller, more frequent meals, avoid trigger foods that cause indigestion (like fatty or highly acidic foods), and limit alcohol intake. If NSAIDs were the cause, your GP will help you find alternative pain relief options, such as paracetamol.

If you are experiencing persistent abdominal pain or indigestion that does not resolve with over-the-counter antacids, you should consult a GP. An online GP can assess your symptoms, discuss your medication history, and determine if an H. pylori test is necessary. They can also provide private prescriptions for acid-suppressing treatments or offer guidance on managing digestive discomfort. Early intervention is key to preventing the ulcer from worsening or leading to complications such as internal bleeding.