What are stomach ulcers? Here’s what you need to know

Stomach ulcers — known by doctors as peptic ulcers — are a deep erosion or sore that can occur in the stomach, small bowel or large bowel.

They can be extremely painful, and, if left untreated, can wreak havoc on your body.

According to Dr. Nikita Patel, a family doctor at the Women’s College Hospital Family Practice Health Centre in Toronto, there are two categories of peptic ulcers: gastric and duodenal.

“[Gastric ulcers] are in the body of the stomach, and [duodenal ulcers] are in the duodenum… which is the beginning part of the small intestine that kind of drains the stomach into the intestine,” Patel told Global News.

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Ulcers aren’t “full thickness holes” in any organ, but they do cause the erosion of the walls of organs. In the case of peptic ulcers, the walls of your stomach or bowel become thinner.

Thankfully, there are some things you can do to lessen your risk of developing stomach ulcers.

What causes stomach ulcers?

There are two main causes of peptic ulcers: nonsteroidal anti-inflammatory drugs (NSAIDs) and a bacteria called Helicobacter pylori (known as H. pylori).

“A lot of older people get put on [NSAIDs] and lots of young women are taking them for menstrual cramps or pain,” said Patel. Examples of common NSAIDs are Advil, ibuprofen, Aleve and Motrin.

“Those are considered high risk factors for getting peptic ulcers because they’re acidic, and they can create holes or erosion in the lining of the stomach when they sit there,” she said.

Patel recommends taking any of these medications with food, “because [it can act] as a buffer or barrier between the pill and the lining of your stomach.”

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H. pylori is a bacteria that creates excess amounts of acid in the stomach.

It’s prevalent in developing nations. According to the Canadian Digestive Health Foundation, approximately 75 per cent of people living in First Nations communities in Canada are infected with H. pylori.

If you’re suspected to have H. pylori, you will be tested in one of two ways: a breath test or an endoscopy.

“Smoking also makes it worse… if you had stomach cancer…drinking caffeine…and stress,” said Patel. “For example, if you had a burn on your body that covers more than 30 per cent of your body surface area, stomach ulcers can result from that.”

Signs and symptoms

Unfortunately, you probably won’t be able to tell you have a peptic ulcer. According to Patel, up to 70 per cent of cases are asymptomatic.

“0.1 to 1.5 per cent of patients will have symptoms of a peptic ulcer in their lifetime, but many of them aren’t found that way,” she said.

If your ulcer does cause symptoms, the most common is dyspepsia, which Patel describes as “upper abdominal pain [or] discomfort.” Sometimes it can move into the back, but it’s typically felt in the front part of the stomach.

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The pain or discomfort typically worsens when you eat “because [your body] makes more acid,” which can irritate the ulcer.

“People might also describe that they’re burping, they feel really full in the upper part of their belly [or] bloated,” Patel said.

It’s also common that people with peptic ulcers will feel like they get full faster — a condition known as early satiety. “It basically means that you’ve only had a few bites of food and you were hungry but as soon as you start eating, you actually [became] full,” she said.

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If the ulcer is in the duodenum, it is more likely to cause pain after a meal or overnight. “About two to five hours after a meal, you’ll get pain because that’s when the food has kind of moved through and now there’s acid moving through,” said Patel.

“Overnight, it can really start to hurt because… we create acid overnight — between 11:00 p.m. and 2:00 a.m. — and that can really irritate the duodenum.”

Nausea and vomiting can also be present.

If a peptic ulcer goes undiagnosed, it can cause complications

If you’re experiencing pain, Patel’s first recommendation is to visit your family doctor.

“First, we’ll take a history and a physical and we’ll make sure [you] don’t have any signs of severe complication,” she said. If you had dark, sticky, tarry blood in your bowel movements or severe abdominal pain, Patel would send you to the emergency room.

If you don’t have severe symptoms, it’s likely your family doctor will make some recommendations based on your lifestyle. “Maybe cut out medication [like Advil], stop smoking, stop drinking alcohol or caffeine, and maybe reduce food that increases acid, like citrus,” she said.

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If your family doctor is very concerned, they may send you for H. pylori testing.

“If they find that bacteria, [you] will be put on two weeks of three to four medications to help get rid of that bug,” said Patel. “It’s very pesky because it can survive in high acid environments.”

Treatment will require an acid suppressant, two antibiotics and the fourth (optional) medication is akin to Pepto Bismal.

Meghan.Collie@globalnews.ca

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