What are stomach ulcers and how to treat them?

Written by: Hussain Abdeh MPharm: 2211840

Published on: 10/06/2021

Updated on: 10/06/2021

Stomach ulcers can be very painful and unpleasant. If left untreated, they can also be very dangerous. They can be caused by a number of factors and last for a long time, especially if they are not treated effectively.

Thankfully, there are various medicines available to both treat and prevent stomach ulcers.

In this article, we will be looking at the causes of stomach ulcers, how different medicines and lifestyle changes can effectively treat them and what else you can do to ease and prevent this problem.

What are stomach ulcers?

Stomach ulcers (sometimes referred to as gastric ulcers) are open sores on the stomach lining. You can also get them in the intestine; these are known as duodenal ulcers. Both stomach and duodenal ulcers are commonly referred to as peptic ulcers.

Stomach ulcers commonly cause a burning or gnawing pain in the centre of the abdomen. This pain can travel from the abdomen up to your neck, down to your belly button, or through to your back. The pain can last anywhere from a few minutes to hours; it mostly starts in the hours after you have eaten. Some people may also find that the pain wakes them up during the night.

However, not all stomach ulcers cause pain. Sometimes, they may manifest themselves as other symptoms, such as heartburn, nausea or indigestion. You may also experience loss of appetite, which may cause weight loss. Vomiting is another symptom.

Stomach ulcers are common and can affect people of all ages, however they mostly occur in individuals over the age of 60. Men are also most likely to develop a stomach ulcer.

What causes stomach ulcers?

Stomach ulcers can be caused by several different factors. Medicines that belong to a group of drugs known as nonsteroidal anti-inflammatory drugs (NSAIDs) can cause stomach ulcers, particularly if they are taken for a long time and in high doses.

If you already have a stomach ulcer, or have ever had one, you may be advised against taking an NSAID. Many common medicines are classed as NSAIDs, including naproxen, ibuprofen and aspirin.

A bacteria called H. pylori can cause infections. This problem is quite common and you can become infected without realising as H. pylori infections are normally asymptomatic. This bacteria lives in your stomach lining and can irritate the lining in some people. This makes it easier for the stomach lining to be damaged by stomach acid.

It is not fully understood how H. pylori infections are spread. It is thought that H. pylori infections can be transmitted from person to person by close contact. H. pylori may be spread through kissing, or through food or water.

Some lifestyle factors can also serve to increase the risks of stomach ulcers, including stress, alcohol, eating spicy foods and smoking.

NSAIDs (non-steroidal anti-inflammatory drugs) and stomach ulcers

If a stomach ulcer has been caused due to taking a nonsteroidal anti-inflammatory drug (NSAID), you will normally be prescribed a PPI like lansoprazole, or Omeprazole by your doctor. They will also advise you on whether or not it is a good idea to keep taking your NSAID medication.

Alternatively, you may also be advised to use an alternative painkiller that has less effect on the stomach, typically paracetamol. If you are required to take NSAID’s for a long-term chronic condition, your doctor will carry out a clinical risk assessment on whether to allow you to keep taking them along side a PPI to add extra protection to the lining of the stomach.

Symptoms of a stomach ulcer

If you have symptoms of a stomach ulcer, you should talk to your doctor.

Because not all stomach ulcers cause pain, you may not notice them until a complication arises. The most common complication of stomach ulcers is internal bleeding, which may cause:

• Vomiting blood
• Passing black, tarry stools
• Pale skin
• Heart palpitations
• Anaemia
• Fatigue
• Breathlessness
• Pale skin

Other, less common symptoms of a stomach ulcer include:

• Indigestion, heartburn or acid reflux
• Feeling or being sick
• Loss of appetite
• Weight loss
• Belching
• Bloating (particularly after eating)

When should you seek medical advice?

If you have a sudden and sharp pain in your stomach that is getting worse, you should also talk to your doctor as soon as possible. Sometimes, perforation may occur. This is when the stomach lining splits open, which allows bacteria to escape and cause infection in the abdomen’s lining. This infection can spread to the blood and cause sepsis, then spread even further to the organs. If this happens, it can be fatal.

Other signs of a serious complication include:

• Vomiting blood
• Stools that are very dark in colour and appear sticky

You should contact your GP immediately if you experience any of the above warning signs. Alternatively you can go to your nearest A&E.

Diagnosing a stomach ulcer

When diagnosing a stomach ulcer, your doctor will need to know if you are taking any medication, particularly if you are taking any NSAIDs.

They may also run tests to see if you are suffering from a Helicobacter pylori (H. pylori) infection. If your GP thinks a H. pylori infection is contributing to your symptoms they are likely to carry out one of the following tests.

• A urea breath test which is used to detect H. pylori infections. This works by detecting the bacteria in several ways, H. pylori breaks down urea into carbon dioxide and ammonia. During the test, you will be given a special liquid to drink, your doctor will then measure the amount of carbon dioxide in the breath that you exhaleto determine if you have a H. pylori infection.
• A stool test which will be used to test for the bacteria.
• A blood test, during the test; your blood will be tested for anti-bodies to the H. pylori infection. Anti-bodies are naturally occurring proteins that help the body fight against infections.

In some cases, your doctor might refer you to a hospital for a gastroscopy, which is when a thin tube with a camera on the end is placed down your throat into the stomach.

Treatment for stomach ulcers

If the cause of your stomach ulcer is H. pylori, the first line treatment for this is a course of antibiotics and a Proton Pump Inhibitor.

Proton pump inhibitors work by stopping the proton pumps in the stomach lining from working properly; this reduces how much acid is produced by the stomach. By stopping the stomach from producing excessive acid, the ulcer is able to heal naturally.

Proton Pump Inhibitors

There are a number of proton pump inhibitors that are commonly prescribed in the Uk for the treatment of stomach ulcers and other acid related conditions. PPI’s often prescribed are:

Lansoprazole Gastro Resistant Capsules

Omeprazole Tablets

Pantoprazole Tablets

All of the above are prescription-only medicines (POM) that can both help to treat and prevent stomach ulcers. If prescribed by a doctor, lansoprazole can be taken by both adults and children.

The normal dose for treating a stomach ulcer with Lansoprazole is 15mg to 30mg each day.

This medication gets to work after 2 or 3 days. However, it can take up to 4 weeks for lansoprazole to take full effect. Your doctor will advise you on how long you should take it for to treat stomach ulcers. They will also monitor your treatment to see how your symptoms improve.

The starting dose for treating a stomach ulcer with Omeprazole is 20mg once daily for 4 weeks. The dose may be increased to 40mg once daily depending on the severity of the ulcer.

The dose for treating a stomach ulcer with Pantoprazole is 40mg once daily for 4 weeks in total. The dose may be increased to 40mg depending on the severity of the ulcer.

For more information regarding PPIs, read our helpful medical guide on Proton Pump Inhibitors (PPIs) and what they are.

Antacids

Antacids are typically available over the counter; however, they provide immediate symptom relief as well as producing a protective coating on the lining of your stomach.

Antacids are most effective when taken directly after a meal, this can help to reduce your symptoms.

Lifestyle changes to prevent stomach ulcers

As well as taking a PPI medicine such as Lansoprazole or Omeprazole, there are certain lifestyle changes you can make which may work to treat and prevent stomach ulcers.

Dietary changes

The food you eat will not cause stomach ulcers, but eating a healthy and balanced diet can be enormously beneficial to your gut’s health.

Some foods are believed to play a part in killing H. pylori and also boosting your body’s healthy bacteria. Some of these foods are:

• Leafy vegetables like spinach
• Cabbage, broccoli, radishes and cauliflower
• Apples
• Olive oil
• Berries like raspberries, blackberries, blueberries and strawberries
• Probiotic-rich foods like yogurt

Lifestyle changes

Certain lifestyles can increase the risk of a stomach ulcer, by making small changes to lifestyle, diet and unhealthy habits the risk of developing a stomach ulcer are reduced.

Giving up smoking may help to safeguard against stomach ulcers. Smoking causes inflammation and also makes the stomach produce more acid, putting you at a greater risk of ulcers.

Cutting down on how much alcohol you consume can also make a difference. This is because alcohol irritates the lining of the stomach.

If you are stressed, finding ways of reducing your stress levels can also help to stop the stomach from producing an excessive amount of acid. Ways you could lower your stress levels include exercising, getting a better night’s sleep or even talking to a therapist about stress management techniques.

When will I start to feel better?

When taking a proton pump inhibitor, you should start to feel better after a few days. However, it can take this medicine up to 4 weeks before it reaches its full effect. In the meantime, you should speak to your doctor about which painkillers it is safe to take to ease any pain you may feel.

Are PPI’s safe to take for a long time?

Generally speaking, lansoprazole is safe to take in the long-term. However, if you take it for longer than 3 months, it can cause your blood’s magnesium levels to drop. If you have lower levels of magnesium you may suffer side effects like tiredness, confusion, muscle twitches, dizziness, shakiness and an irregular heartbeat. If you take lansoprazole for longer than 3 months and get any of these symptoms, talk to your doctor.

If you need to take this medication for more than 12 months, your doctor will need to monitor your health regularly to make sure it is safe. This is because you may be at a greater risk of vitamin B12 deficiency, gut infections and bone fractures when taking lansoprazole for longer than one year.

What does stomach ulcer pain feel like?

The main symptoms and pain you will experience when suffering from a stomach ulcer is abdominal pain. The pain will feel like a burning sensation in your stomach. However, not all stomach ulcers cause pain until a complication arises that may present a more serious issue.

Do stomach ulcers go away on its own?

Stomach ulcers can often heal themselves, however if the main cause of the stomach ulcer has not been eliminated it is unlikely the stomach will have a chance to heal itself.

Does stress cause stomach ulcers?

Yes, stress is one of the main causes of a stomach ulcer. A stress ulcer can cause sores in the upper gastrointestinal tract causing a burning sensation and pain in the stomach.

Summary

In conclusion, Proton pump inhibitors are an effective and powerful medicine for stomach ulcers. This PPI should have significantly improved your ulcer after a few weeks of use. As always, you should take care to follow your doctor’s dosage instructions to ensure effective treatment.

If lansoprazole is not suitable for you, there are other proton pump inhibitors that can also be taken to treat and prevent stomach ulcers. The likes of pantoprazole or omeprazole may be safer for you to use.

Other lifestyle changes should not be overlooked when it comes to treating, preventing and decreasing the risk of developing a stomach ulcer.

References

https://www.nhs.uk/medicines/lansoprazole/

https://www.nhs.uk/medicines/pantoprazole/

https://www.mayoclinic.org/diseases-conditions/h-pylori/symptoms-causes/syc-20356171

https://www.healthline.com/health/stomach-ulcer/

https://www.medicalnewstoday.com/articles/324990