Stomach and duodenal ulcers
An ulcer is not simply an "irritated stomach" but a genuine defect in its wall: in one spot the lining has been destroyed down to the deeper layers.
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Medicines commonly prescribed for Stomach and duodenal ulcers
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: TABLET, 500 mgActive substance: clarithromycinManufacturer: Accord Healthcare S.L.U.Prescription requiredDosage form: TABLET, 500 mgActive substance: clarithromycinManufacturer: Sandoz Farmaceutica S.A.Prescription requiredDosage form: CAPSULE, 40 mgActive substance: omeprazoleManufacturer: Laboratorios Alter S.A.Prescription required
An ulcer is not simply an "irritated stomach" but a genuine defect in its wall: in one spot the lining has been destroyed down to the deeper layers. That sounds serious, and it is, yet the story almost always ends well — find the cause, remove it, and the defect heals over in a few weeks and does not come back. The catch is that the cause is usually looked for in the wrong place. Ulcers are popularly blamed on stressful jobs and spicy food, whereas in reality two things lie behind nearly all of them: the bacterium Helicobacter pylori and painkillers from the anti-inflammatory group. Both can be tested for and both can be removed. This page also covers duodenal ulcers, which are even more common than gastric ones and behave very much alike.
How an ulcer announces itself
The main sign is pain high in the tummy, at the pit of the stomach. It is usually burning or gnawing, lasts from minutes to hours, and unlike many other kinds of tummy pain it has a recognisable rhythm.
- With a duodenal ulcer the pain comes on an empty stomach and at night, wakes you in the early hours and settles as soon as you eat or drink something bland.
- With a gastric ulcer it is the other way round: it worsens soon after eating, and people start eating less to avoid provoking it.
- Between flare-ups there are quiet weeks or months, after which it all returns, often at the same time of year.
Besides pain there may be heartburn, burping, bloating, nausea and a full feeling after a small portion. It is just as important to know the opposite: an ulcer can be completely silent. That applies above all to ulcers caused by painkillers, which often give no warning at all until they bleed, and it happens most to older people taking these medicines continuously. So the absence of pain is no proof that the stomach is fine.
What actually causes an ulcer
The stomach lining works in acid every day and defends itself with a layer of mucus, with bicarbonate and with very rapid cell renewal. An ulcer appears when something breaks through that defence.
Helicobacter pylori. The bacterium settles in the mucus on the stomach surface, neutralises the acid around itself and keeps inflammation going for years. Infection is usually picked up in childhood, within the family, through shared crockery. Carrying it is very common and in most people amounts to nothing, but it is what lies behind most duodenal ulcers and many gastric ones. The infection is found with a simple test and cleared with a course of about two weeks — after which the ulcer not only heals but stops recurring.
Anti-inflammatory painkillers. These are ibuprofen, diclofenac, naproxen, ketorolac and aspirin. They cut the production of the substances that maintain the protective mucus layer, and they do so throughout the body, so a suppository, an injection or a "cold and flu" sachet is no safer than a tablet. The risk is higher with long-term use, in older people, when several such medicines are combined, and when they are taken alongside steroids or blood thinners. Look through your medicine cupboard carefully: a painkiller often hides inside combination remedies that nobody thinks of as a drug.
Smoking, which slows healing, and spirits round out the picture. Stress and spicy food, on the other hand, do not cause ulcers: they can sharpen sensations that already exist, but they cannot breach the stomach wall. The practical conclusion is that treatment consisting of a holiday and a bland diet leaves the cause untouched.
When acid tablets on their own are not enough
The complaints of an ulcer and those of more serious stomach disease overlap, and no one can tell them apart by feel. That is why there is a short list of signs after which you cannot stop at acid-lowering medicines: the stomach has to be looked at from the inside. See a doctor within the next few days if even one of these is present:
- difficulty swallowing — food goes down badly, sticks, needs washing down;
- vomiting blood or dark material that looks like coffee grounds, even once and even if it has passed;
- black, tarry stools;
- weight loss you cannot explain by diet or exercise;
- persistent or repeated vomiting;
- growing weakness, pallor and breathlessness on exertion — that is anaemia from unnoticed blood loss;
- stomach complaints appearing for the first time in later life.
None of these points means you certainly have something dreadful. They mean something else: the question is settled by a gastroscopy, not by blindly trying yet another medicine.
Complications and how to recognise them
Complications are uncommon, but they are what makes an ulcer dangerous, and they need recognising from the first minutes.
Bleeding is the most frequent. The ulcer erodes a vessel in the wall and blood enters the stomach. The signs are: vomiting bright red blood or contents the colour of coffee grounds; black, sticky, strong-smelling tarry stools; growing weakness, ringing in the ears, cold sweat, a racing heart, fainting on standing up. Sometimes the loss trickles on for weeks and its only sign is anaemia.
Perforation is a hole right through the wall, letting the contents into the abdominal cavity. It begins abruptly: a sharp, stabbing pain that leaves the person motionless and afraid to shift, with a board-hard abdomen that hurts at the lightest touch. This is a situation counted in hours.
Narrowing of the stomach outlet develops slowly, from scarring and swelling. Food stops passing on: there is stubborn vomiting, often of food eaten the day before, a sense of fullness, a sloshing sound in the abdomen and rapid weight loss.
With any of these signs, call an ambulance. Do not drive and do not try to get there yourself — ask someone to take you or call for an ambulance; in Spain, Italy, Portugal, Poland and Ukraine the single European number 112 is used for this. Do not eat or drink while you wait, and take the list of your medicines with you: it tells a doctor more than a long account.
How the diagnosis is confirmed
The work-up begins with the search for Helicobacter, because everything that follows depends on the result. A urea breath test, a stool test for the bacterial antigen, or a biopsy taken at gastroscopy are used. Blood antibody tests serve poorly here: they stay positive long after the infection has gone.
The tests need preparation, otherwise the result comes back falsely negative. Acid-lowering medicines are stopped roughly two weeks beforehand, antibiotics and bismuth about four; the exact intervals are given by the doctor requesting the test. A full blood count is usually taken as well, so that hidden blood loss is not missed, along with iron studies.
Not everyone needs a gastroscopy. It is arranged for the warning signs listed above, when treatment fails, when flare-ups keep repeating, and when symptoms appear for the first time in later life. The doctor sees the ulcer directly, judges its size and its base, stops bleeding on the spot if needed and takes tissue samples. For a gastric ulcer the biopsy is obligatory: from the outside an ulcer and a tumour can look identical, and only the laboratory separates them. For the same reason a stomach ulcer is often looked at again after treatment, to make sure it has healed completely.
Treatment, and what to do about painkillers
Treatment is built around the cause that was found, and it works well: done properly, almost all ulcers heal.
- If Helicobacter is found, eradication is given: two or three antibiotics together with an acid-suppressing medicine for about two weeks. The regimen is chosen by the doctor with an eye on local resistance and on which antibiotics you have had before. Finishing the course matters: a half-finished one does not clear the infection but does help it become resistant. About a month after the end, a test checks whether the bacterium has gone, and that result decides whether it worked.
- Proton pump inhibitors reduce acidity and give the defect a chance to heal. They are taken from a few weeks to a couple of months, depending on the size of the ulcer and its cause.
- Antacids and alginates act quickly and briefly; they suit occasional relief and do not replace treating the cause.
Painkillers deserve a separate conversation. If the ulcer is linked to them, the medicine is stopped where possible or swapped for one that works differently. But there is an important caveat: aspirin prescribed by a cardiologist to protect the heart and blood vessels is not taken "for pain", and stopping it on your own can end in a heart attack or a stroke. That decision is made only with a doctor, and most often the medicine stays while the stomach is covered with an acid suppressant. The same holds for long-term anti-inflammatory treatment in joint disease: it is reviewed, not broken off at your own risk.
What helps healing and keeps it from returning
Strict pureed diets have not proved their worth, and there is no need to live on porridge for years. Simpler things make the difference: drop whatever personally worsens your pain, eat smaller portions, finish your evening meal about three hours before bed, cut back on coffee and strong tea on an empty stomach, and leave spirits alone at least while you are being treated. The heaviest of all the habits is smoking: it slows healing and clearly raises the chance that the ulcer will come back.
Keep painkillers under control: when you buy a packet for a headache, remember that it is the same medicine that started all this. And if the pain returns after treatment, that is a reason to see a doctor rather than restart the medicine yourself — the infection may not have cleared, or the cause may have been something else.
Online consultation
A remote appointment covers most of the ground for ulcer-type complaints. The doctor will ask about the rhythm of the pain and its link to meals, go through your medicine cupboard with you and find the drugs that may have set it all off, explain where to start — with the Helicobacter test or straight with a gastroscopy — and issue the requests. It is also useful for making sense of reports you already hold: descriptions such as "erosive bulbitis" or "scarred deformity of the duodenal bulb" sound alarming yet mean things of very different weight. Online is a convenient place to run the treatment itself as well: check the eradication regimen, decide what to do about antibiotic side effects, arrange the check test a month later, and discuss how to handle painkillers you need for something else. The one thing that has no place in this format is trying to sit out the warning signs. Vomiting blood, black stools and sudden severe tummy pain are not discussed by message but with an ambulance.
This material is for information only and does not replace medical advice.
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