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Peptic Ulcer 

What is a peptic ulcer?

A peptic ulcer is a raw area or small hole in the lining of the stomach or the duodenum (the first part of the small intestine). Most ulcers occur in the duodenum (duodenal ulcers); a smaller number develop in the stomach (gastric ulcers).

What causes a peptic ulcer?

Gastric juice produced by the lining of the stomach contains acid and an enzyme (called pepsin) that digests protein in our food. This acidic juice can cause an erosion of the lining of the stomach or duodenum if it is excessive. This lining is normally protected by a layer of thick mucus, like a coating of slime. Once it is broken, the raw area of an ulcer can form. A common modern cause is the use of drugs to treat pain and arthritis, known as non-steroidal anti-inflammatory drugs (NSAIDS).

What are the symptoms?

Common symptoms are:

• upper abdominal pain (just under the ribs)
• heartburn or indigestion
• 'hunger pain' when the stomach is empty (between meals and at night)
• pain relieved by antacids and milk

Uncommon symptoms are:

• back pain (between the shoulder blades)
• bleeding-vomiting blood and blood in motions

Who is prone to ulcers?

Ulcers are common in:

• men
• young to middle-aged adults
• those who constantly take certain drugs (e.g. aspirin, cortisone, NSAIDS)
• heavy smokers
• heavy alcohol drinkers
• those who suffer constant stress and anxiety

What the risks?

Most ulcers are relatively easy to cure or control. Bleeding can result in anaemia or can be sudden, and this is an emergency. Perforation or blockage of the duodenum can occur. Cancer rarely occurs with a gastric ulcer.

What is the treatment?

Self-help

• Do not smoke.
• Drink alcohol only in moderation.
• Do not swallow aspirin or anti-arthritic drugs unless really necessary.
• Follow a normal healthy diet with 3 balanced meals a day.
• Do not skip meals, eat irregularly or have late-night snacks.
• Avoid any foods that make your symptoms worse.
• Continue your normal activities, but aim for a non-stressful lifestyle.
• Take antacid tablets or medicines to relieve symptoms.

Medical help

• Your ulcer problem should be managed with the advice of your doctor. Antacids may not be enough, and special drugs are now available to heal ulcers. These modern drugs reduce the output of gastric juice and need to be taken exactly as instructed. If all these things fail, an operation can be very successful.
• Peptic ulcers are now very treatable with excellent modern drugs, and so any suffering should not be necessary.
• Report any sudden severe stomach pain or vomiting or passing of blood.

Copyright 1995: John Murtagh, Professor of General Practice
Monash University, Melbourne, Australia