Peptic ulcer


Updated July 2006

An eroded area of the tissue lining the stomach or the duodenum. Stress, excess alcohol, smoking, and unsanitary conditions are risk factors. The main cause of this pathology in the elderly is the taking of prescription non steroidal anti inflammatory drugs – NSAIDs (which are severe gastric irritants) for rheumatism.

The lining of the stomach and duodenum normally has a barrier of mucus to protect it from the effects of acidic digestive juices. If this barrier is damaged, the acid may cause inflammation and erosion of the lining. The resulting eroded areas are known as peptic ulcers, of which there are two types: duodenal ulcers and gastric (stomach) ulcers. Duodenal ulcers are more common than gastric ulcers and usually occur in people ages 20 to 45, particularly men. Gastric ulcers are more common in people over the age of 50. It is estimated that about one in 10 people in the UK develops an ulcer at some time.

Many people with a peptic ulcer do not experience symptoms or dismiss their discomfort as indigestion. Those with persistent symptoms may notice:
  • pain or discomfort that is felt in the upper abdomen
  • loss of appetite and weight loss
  • a feeling of fullness in the abdomen
  • nausea and sometimes vomiting
Pain is often present for several weeks and then disappears for months or even years. The pain from a duodenal ulcer can be worse before meals when the stomach is empty. This pain may be quickly relieved by eating, but usually recurs a few hours afterwards. By contrast, pain caused by a gastric ulcer is often aggravated by food.

If an ulcer is suspected, an endoscopy can be arranged to view the stomach or duodenum. Blood tests may also be performed to detect antibodies against the H. pylori bacterium and to check for evidence of anaemia. Treatment of a peptic ulcer is designed to heal the ulcer and to prevent it from recurring. Lifestyle changes, such as giving up smoking and drinking less alcohol may also help. With treatment, about 19 in 20 peptic ulcers disappear completely within a few months. However, the ulcer may recur if lifestyle changes are not made or if there is re-infection with H. pylori.

Bleeding from an ulcer carries a much greater risk of death and poor outcome in the elderly and therefore symptoms suggesting a bleed such as vomiting blood or black stools (melaena) usually dictate the need for urgent hospital admission.

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