Peptic Ulcer: Burning Stomach Pain, H. pylori, NSAIDs and Warning Signs

What it involves

MedlinePlus defines a peptic ulcer as an open sore in the lining of the stomach, called a gastric ulcer, or in the first part of the small intestine, called a duodenal ulcer. The lining normally resists stomach acid, and an ulcer forms when that protection breaks down.

Who this is for

• Patients with burning or gnawing pain in the upper belly that comes one to three hours after meals or at night
• Patients who take ibuprofen, naproxen, or aspirin regularly and have stomach pain or heartburn
• Patients who have noticed dark, tarry stools, or vomiting that looks bloody
• Patients with ongoing heartburn who want to know whether something more than reflux is going on

What to expect

• Questions about the pain pattern, pain medicines, alcohol, smoking, and any black stools or vomiting
• A belly exam and a review of anything that could irritate the stomach lining
• Tests the provider chooses, which MedlinePlus says can include a blood count and a check for H. pylori
• A plan that may include acid-lowering medicine, a change in pain medicines, or a referral for endoscopy

The usual causes

MedlinePlus says the most common cause is infection of the stomach with Helicobacter pylori bacteria, although many people who carry it never get an ulcer. Other things that raise the risk include heavy drinking, regular use of aspirin, ibuprofen, naproxen, or similar anti-inflammatory pills, smoking or chewing tobacco, being very ill, radiation treatment, and stress. A rare condition that makes the stomach produce excess acid can also cause ulcers.

What the pain is like

Pain is often in the upper middle belly and differs from person to person, and some people feel none. MedlinePlus says it may occur at night and wake you, or on an empty stomach one to three hours after eating. Other possible symptoms:

• Nausea, vomiting, a feeling of fullness, and trouble drinking as much as usual
• Ongoing heartburn, fatigue, and weight loss
• Bloody or dark, tarry stools, or vomit that may contain blood
• Chest pain in some people

Heartburn versus an ulcer

Heartburn from acid reflux and ulcers can feel alike, and a provider sorts out which fits. The heartburn and acid reflux guide describes reflux, and the abdominal pain guide explains how belly pain is worked through by location and pattern.

How it is diagnosed

MedlinePlus says many people with a suspected ulcer have an upper endoscopy, where a thin camera is passed down the throat, especially with anemia, trouble swallowing, bloody vomit or stools, unplanned weight loss, or other worrying findings. It also lists H. pylori testing by stool test, breath test, or biopsy, a hemoglobin test for anemia, and a stool test for hidden blood. Endoscopy is done by a specialist, and the anemia guide explains the blood count.

Treatment

MedlinePlus says medicine heals the ulcer and prevents it from coming back. When H. pylori is present the standard treatment combines two antibiotics with an acid-reducing medicine for 7 to 14 days, sometimes with bismuth. Without H. pylori, or when caused by pain pills, a proton pump inhibitor is usually taken for about eight weeks. MedlinePlus adds that peptic ulcers tend to return if untreated.

Pain pills and prevention

MedlinePlus advises avoiding aspirin, ibuprofen, naproxen, and similar medicines when possible and trying acetaminophen instead. If you must take them, talk to a provider first, who may test for H. pylori, add acid protection, or prescribe a preventive medicine. It also says not to smoke or chew tobacco, and to avoid alcohol.

When it is an emergency

MedlinePlus says to get medical help right away for sudden sharp belly pain, a rigid hard and tender belly, signs of shock such as fainting, heavy sweating or confusion, vomiting blood, or maroon or black tarry stools. A hole in the stomach wall is a medical emergency. Contact a provider about feeling dizzy or lightheaded, or any ulcer symptoms.

Sources

• MedlinePlus — Peptic ulcer
• MedlinePlus — Peptic Ulcer health topic