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Heartburn and Ulcers

An ulcer is a recurring open wound or a wound that heals slowly. When it occurs on the inner lining of the stomach, small intestine or oesophagus it is called a peptic ulcer.

What is peptic ulcer disease?

Stomach ulcers and ulcers of the first part of the small intestine, called the duodenum, are sometimes called peptic ulcers.1,2

What causes peptic ulcers?

Research shows that around 1 in 10 people may have a peptic ulcer at some point in their life. Peptic ulcers can affect people of any age, including children, but mostly occur in people aged 60 or older. Men tend to be more commonly affected than women. 1
Ulcers develop when the normal defence and repair mechanisms of the lining of the stomach or duodenum are weakened.

Certain lifestyle factors may increase the likelihood of peptic ulcers, or make the symptoms worse: 1,2,3

What are the symptoms of peptic ulcer?

The most common symptom of peptic ulcer is a mild to moderate pain just below your breastbone. This is often described as gnawing, burning, aching, or soreness or sometimes as a sensation of hunger.1,2,3

Less common symptoms of a stomach ulcer can include: 1,2


  • indigestion
  • heartburn
  • loss of appetite
  • feeling and being sick
  • weight loss

How is peptic ulcer diagnosed?

If your doctor suspects you have an ulcer, you may be referred for a gastroscopy which is usually done as an outpatient procedure. You may be given a mild sedative injection and have your throat sprayed with a local anaesthetic before a thin, flexible tube (an endoscope) with a camera at one end is passed into your mouth and down into your stomach and first section of the small intestine (duodenum). 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.1,3

If your doctor suspects that your ulcer is caused by H. pylori infection, they may recommend one of the following tests: 1,2

Peptic ulcers are open sores that develop in the lining of the stomach or the duodenum.1,3

The most common causes of peptic ulcers are: 1,3,4,5,6

Both H. pylori and NSAIDs 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.1,3

How is peptic ulcer treated?

Your treatment will depend on what caused your peptic ulcer, but it will include a class of medicine that inhibits gastric acid secretion.1,2 With treatment, most ulcers heal in a month or two.1

Commonly used acid reducing medications are:

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.1

Your doctor may also recommend taking additional antacid medication to neutralise your stomach acid and provide immediate, short-term, symptom relief. Some antacids also contain a medicine called an alginate, which produces a protective coating on the lining of your stomach.1,3

If your stomach ulcer is caused by H. pylori infection, you may be prescribed a course of antibiotics and a proton pump inhibitor (PPI).1 If the infection is treated successfully, peptic ulcer disease comes back in less than 10 % of people.3

If your stomach ulcer is just caused by taking NSAIDs, a course of PPI medication is recommended. Your doctor may recommend an alternative painkiller to NSAIDs.1

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.1,3

Medical References

1. NHS Choices. Stomach ulcer. Available from: URL: https://www.nhs.uk/Conditions/Peptic-ulcer. Last accessed 30 October 2017. 2. Malfertheiner P, Chan FKL, McColl KEL. Peptic ulcer disease. Lancet 2009; Published Online August 14, 2009; DOI:10.1016/S0140-6736(09)60938-7. 3. Vakil N. Peptic Ulcer Disease. Merck Manual Consumer Version. Available from: URL: http://www.merckmanuals.com/home/digestive-disorders/gastritis-and-peptic-ulcer-disease/peptic-ulcer-disease. Last accessed 26 October 2017. 4. Go MF. Review article: natural history and epidemiology of Helicobacter pylori infection. Aliment Pharmacol Ther 2002;16(Suppl. 1):3-15. 5. Malfertheiner P, Megraud F, O’Morain CA, Atherton J, Axon ATR, Baxxoli R, et al. The European Helicobacter Study Group (EHSG). Management of Helicobacter pylori infection-the Maastricht IV/ Florence Consensus Report. Gut 2012;61:646-664. 6. Chan FKL, Chung SCS, Suen BY, Lee YT, Leung WK, Leung VKS, et al. Preventing Recurrent Upper Gastrointestinal Bleeding In Patients With Helicobacter Pylori Infection Who Are Taking Low-Dose Aspirin Or Naproxen. N Engl J Med 2001;344(13):967-973. 7. Lau JY, Sung J, Hill C, Henderson C, Howden CW, Metz DC. Systematic Review of the Epidemiology of Complicated Peptic Ulcer Disease: Incidence, Recurrence, Risk Factors and Mortality. Digestion 2011;84:102-113. ZA/11/2017-2019/OMEZ/060. 33965 12/17

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