What increases the risks of having an ulcer?
Sometimes there is no apparent explanation for the development of an ulcer. However, it is known that smoking, heavy alcohol intake—especially spirits—and certain medicines such as aspirin and anti-inflammatory drugs, can cause ulcers to develop or make existing ones worse. The action of aspirin and other anti-inflammatory drugs prevent the formation of protective substances and are in themselves harmful to the stomach lining. They can also cause ulcers to bleed. Patients who regularly have to take aspirin or anti-inflammatory pain killing drugs should discuss with their doctor how to minimize the effects on their stomach.

Smoking makes ulcers more likely to develop and also slows the healing process. It also makes recurrence more likely.

Stress probably does not cause ulcers, but does worsen symptoms if an ulcer is present. Stressful situations worsen their symptoms, possibly because the stomach produces more acid in response to stress.

What tests confirm the presence of an ulcer?
The usual tests used are either an endoscopy or a barium meal. These are usually done on an out-patient basis:

Endoscopy— After going without food, the patient is helped to swallow a slim flexible tube with a small camera at its tip that enables the lining of the gullet, the stomach and duodenum to be seen on a monitor. Before the procedure is carried out, the patient will receive a mild sedative and/or a numbing agent for the back of the mouth/throat. When necessary, samples for a biopsy and to test for H. pylori can be taken for analysis.

Barium meal— A barium meal is an x-ray that involves swallowing a tasteless, white liquid. Ulcers show up as craters or pits in the lining of the stomach and duodenum.

How is an ulcer treated?
About one-third of duodenal ulcers heal by themselves within a month. Dietary treatment used to be recommended for ulcers, but drug treatment is now so effective that the main dietary advice is simply to avoid foods that cause indigestion. These foods vary from patient to patient. A bland diet is not necessary but it is sensible to ensure regular meals. The aim of treatment is to:

  • eradicate H. pylori infection when present. Combinations of drugs including antibiotics are used for 1 or 2 weeks to kill the bacteria.
  • reduce stomach acid. The most commonly used drugs do this by inhibiting the cells that produce gastric acid. Antacids, such as Milk of Magnesia, act by neutralizing, for a short time, the acid after it has been produced.
  • boost the body’s defenses. Other drugs help the stomach lining to resist being ‘eaten’ away by the digestive process.

Generally ulcer drugs have few side effects. Some antacids may cause constipation, others may cause diarrhea. Antibiotic treatments are less pleasant and may cause mild stomach upset and diarrhea. They are usually only given for 1–2 weeks.

Do ulcers come back after treatment?
Most ulcers heal in 4 to 8 weeks but they are very likely to come back in the future unless the H. pylori infection is successfully treated. If the bacteria is killed by treatment, the chances of recurrence are small. Where this is not achieved, or the ulcer is not caused by infection, then another way of preventing ulcer recurrence is to continue to take acid-reducing tablets.

Is surgery necessary to treat ulcers?
Because we now have such effective medical treatment, surgery is rarely needed today. Occasionally, surgery may be required as an emergency if a deep ulcer causes a complication, such as bleeding or perforation of the wall of the stomach or duodenum. There are also a few people who had ulcers years ago and have persisting problems as a result of scarring. This may cause a narrowing of the centre of the stomach which can be relieved by surgery or endoscopy.

Further informationNational Digestive Diseases Information Clearinghouse (NDDIC): http://digestive.niddk.nih.gov/ddiseases/pubs/hpylori/index.htm

Last reviewed: July 2011