Peptic Ulcers

A peptic ulcer is an open sore that develops in the lining of the stomach or the first part of the small intestine (the duodenum). Ulcers can cause burning or gnawing pain in the upper abdomen and may also lead to nausea, bloating, or indigestion-type symptoms.

Most peptic ulcers are caused by Helicobacter pylori (H. pylori) infection or by long-term use of non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen. With the right treatment, most ulcers heal and symptoms improve.

At the Royal Buckinghamshire Hospital, we provide consultant-led assessment and investigation to confirm the cause and recommend an effective treatment plan.

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Types of Peptic Ulcer

• Gastric ulcer
  An ulcer in the stomach lining.
• Duodenal ulcer
  An ulcer in the duodenum (the first part of the small intestine).

Both can cause similar symptoms, though the timing of pain in relation to meals can differ between people.

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Common Causes of Peptic Ulcers

1) H. pylori infection

H. pylori is a common bacteria that can weaken the protective lining of the stomach or duodenum, making it easier for acid to cause an ulcer.

2) NSAID use

NSAIDs can reduce the stomach’s protective mucus layer. Risk increases with:

• Higher doses or prolonged use
• Older age
• Previous ulcers
• Taking NSAIDs alongside steroids, aspirin, or certain blood thinners

Other contributing factors

• Smoking (increases ulcer risk and slows healing)
• Excess alcohol (can irritate the stomach lining)
• Severe physiological stress (less common, usually in hospitalised patients)

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Symptoms of Peptic Ulcers

Symptoms vary, and some people have mild or no symptoms. Common symptoms include:

• Burning or gnawing pain in the upper abdomen
• Pain that may come and go
• Indigestion or heartburn-like symptoms
• Bloating or feeling full quickly
• Nausea or vomiting
• Loss of appetite
• Unintentional weight loss (less common)

Symptoms that may indicate bleeding or complications

Seek urgent assessment if you have:

• Vomiting blood (fresh blood or “coffee ground” appearance)
• Black, tarry stools
• Sudden severe abdominal pain
• Feeling faint, dizzy, or very weak

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Diagnosis at Royal Buckinghamshire Hospital

Your consultant will review your symptoms and risk factors (including NSAID use). Diagnosis may include:

• H. pylori testing (breath test, stool test, or blood test depending on situation)
• Blood tests to check for anaemia if bleeding is suspected
• Gastroscopy (endoscopy) to look directly at the stomach/duodenum, especially if:
  • symptoms are persistent or severe
  • you are over a certain age threshold with new symptoms
  • there are “alarm” features (weight loss, swallowing difficulty, anaemia, bleeding, persistent vomiting)
  • treatment has not helped

If a gastric ulcer is seen, biopsies may be taken to rule out other causes.

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Treatment & Management

Treatment depends on the cause and whether there are complications.

Acid suppression (core treatment)

Most patients are treated with a proton pump inhibitor (PPI) to reduce stomach acid and allow healing.

Treating H. pylori

If H. pylori is present, treatment usually involves a short course of combination antibiotics plus a PPI.

If NSAIDs are contributing

Your consultant may recommend:

• Stopping or reducing NSAIDs where possible
• Switching pain relief options
• Using protective medication if NSAIDs are required
• Reviewing aspirin or blood thinner use with your clinician

Lifestyle support

• Stop smoking
• Reduce alcohol intake
• Avoid foods that clearly trigger symptoms (this varies by person)
• Regular meals can help some people, but diet alone does not treat the underlying cause

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Possible Complications

Untreated peptic ulcers can lead to:

• Bleeding (most common serious complication)
• Perforation (a hole in the stomach/duodenal wall)
• Gastric outlet obstruction (blockage causing vomiting and weight loss)

These complications require urgent medical attention.

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When to seek urgent help

Seek urgent same-day medical advice or emergency care if you experience:

• Vomiting blood or black stools
• Sudden severe abdominal pain
• Severe dizziness/fainting or signs of significant blood loss
• Persistent vomiting or inability to keep fluids down

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If you have upper abdominal pain, indigestion symptoms that are not settling, or concerns about peptic ulcers (especially if you take NSAIDs), contact Royal Buckinghamshire Hospital for assessment and treatment planning. There is no need to be registered with the hospital, or live locally.

If you have insurance which covers consultations, we can in most cases invoice the insurer directly. Where you are paying directly, any costs will always be discussed.