Stomach ulcer (gastric ulcer)

A stomach ulcer is a sore in the protective lining of the gastrointestinal tract.

Ulcers can also occur in a 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.

The two main causes of stomach ulcers are:

  • Helicobacter pylori (H. pylori) bacteria, which can irritate the stomach or upper intestine lining, causing an ulcer to form
  • Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or aspirin, which can have a similar effect.

Stomach ulcers are common. About 1 in 10 people will reportedly have a stomach ulcer at some point in their life.

Stomach ulcers can affect people of any age, including children, but mostly people aged 60 or over. You may have an increased risk of a stomach ulcer if you smoke or drink excessive amounts of alcohol. Stomach ulcers and stress are linked in that while stress can exacerbate them, it does not cause them.

What are its symptoms?

The most common symptom of a stomach ulcer is a burning or gnawing pain in the centre of the abdomen. This is caused by the ulcer and is aggravated by stomach acid coming in contact with the ulcerated area. The pain typically may:

  • Be felt anywhere from your navel up to your breastbone
  • Be worse when your stomach is empty
  • Flare up at night
  • Often be temporarily relieved by eating certain foods that buffer stomach acid or by taking an acid-reducing medication
  • Disappear and then return for a few days or weeks.

Less often, ulcers may cause severe signs or symptoms such as:

  • The vomiting of blood (which may appear red or black)
  • Dark blood in stools or stools that are black or tarry
  • Nausea or throwing up blood
  • Unexplained weight loss
  • Appetite changes.

People who have stomach ulcers generally continue to function quite comfortably and some ulcers heal spontaneously without medication.

However, left untreated, stomach ulcers can cause complications, including bleeding, perforation and obstruction of the gastric system.

How is it diagnosed?

See your doctor if you have persistent signs and symptoms that worry you. Over-the-counter antacids and acid blockers may relieve the gnawing pain, but the relief is short-lived. If the stomach ulcer pain persists, see your doctor.

Your doctor will ask you about your symptoms, medical history and give you a physical examination.

To be sure of a stomach ulcer diagnosis, you will need to undergo diagnostic tests, such as:

  • Tests for H. pylori: These tests include your blood, stool and breath
  • An endoscopy: A scope is used to examine your upper digestive system. Your doctor passes a hollow tube equipped with a lens (endoscope) down your throat and into your oesophagus, stomach and small intestine. If an ulcer is detected, small tissue samples (a biopsy) may be removed for examination in a lab.
  • X-ray of your upper digestive system: Sometimes called a barium swallow or upper gastrointestinal series, this series of X-rays creates images of your oesophagus, stomach and small intestine.

What are your treatment options?

Medication can be used to bring stomach ulcer relief. A type of medication known as a proton pump inhibitor can usually reduce the amount of acid in your digestive system, allowing the ulcer to heal.

If an H. pylori infection is responsible for the ulcers, a combination of antibiotics can be used to kill the bacteria, which should prevent the ulcer coming back.

If the ulcers are related to the use of NSAIDs, they are usually stopped and proton pump inhibitors used. In the case of aspirin-induced ulcers, the aspirin sometimes needs to be continued, depending on why it is being given.

Surgery may be necessary if all the medications for treating peptic ulcers are unsuccessful or if serious complications develop. In the case of a bleeding ulcer, the doctor will repair the source of the bleeding.

If the ulcer has perforated the stomach or duodenal wall, an emergency operation is required to close the perforation.

Can it be prevented?

You can greatly reduce your chances of getting a stomach ulcer if you:

  • Stop smoking. Smoking is one factor closely linked to poor healing and ulcer recurrence. Cigarette smokers often continue to suffer from ulcers until they quit.
  • Avoid trigger foods in your diet such as coffee, chocolate, alcohol, peppermint, tomatoes, tomato-based products, fatty foods, spicy foods and food seasoning such as black pepper, garlic and chilli powder. Citrus fruits may cause discomfort for some people.
  • Stop taking harmful medications. People with ulcers caused by NSAID use must discontinue the offending drug. People who need ongoing pain relief for a condition such as arthritis should ask their doctor to prescribe alternative medication. Steroids also cause peptic ulceration. 
  • Exercise to raise your endorphin levels. People with ulcers may benefit from relaxation techniques and biofeedback to cope with stress. Regular exercise promotes the release of endorphins, brain chemicals that dull pain and elevate mood.
The accuracy of this information was checked and approved by physician Dr Thomas Blake in June 2015