Stomach ulcer

What is a stomach ulcer?

Stomach (gastric) and duodenal ulcers are breaks in the lining of the stomach or the proximal small intestine. That mucosal break is what separates ulcer disease from functional indigestion names that are used when investigation has not found an ulcer.

The two main causes are Helicobacter pylori infection and regular NSAID use. Smoking and increasing age are additional risk factors. Sources: NHS — Stomach ulcer; BNF/NICE Helicobacter pylori treatment summary.

How it is diagnosed

Testing for H. pylori (breath, stool or blood test, with the correct test conditions) and gastroscopy are key investigations when a clinician is looking for ulcer disease. This page is not a self-test. Sources: NHS — Stomach ulcer; BSG test-and-treat education.

Common symptoms

• Upper-abdominal pain (often burning and worse at night)
• Indigestion and heartburn
• Bloating
• Nausea or vomiting

Source: NHS — Stomach ulcer.

Common patterns

• Symptoms that cluster around meals or night-time pain
• History of NSAID or aspirin use
• Prior or suspected H. pylori infection

Overlapping conditions

Ulcer pathways sit next to other upper-gut guides on this site:

• Functional dyspepsia — indigestion when tests have not found an ulcer
• GORD / GERD — heartburn and regurgitation
• Gastritis and H. pylori care often share the same NHS/NICE door; keep the focus here on a mucosal break

Research and commissioning

UK pathways draw on NHS patient guidance, NICE CG184 (GORD and dyspepsia, including peptic ulcer), BSG education on test-and-treat for H. pylori in dyspepsia, and the BNF/NICE eradication treatment summary. Sources listed below.

Approaches people discuss

Ulcer care is cause-directed and clinician-led. This is informational, not a protocol.

• Established Test for H. pylori and treat with eradication (antibiotics plus acid suppression) when infection is confirmed — a clinician decision. Sources: NHS — Stomach ulcer; BNF/NICE; BSG test-and-treat.
• Established Proton-pump inhibitors (PPIs) for NSAID-related ulcers, with review of the NSAID itself where possible. Sources: NHS — Stomach ulcer; NICE CG184 peptic ulcer chapter.
• Established Supportive lifestyle changes: smoking cessation, cutting down alcohol, and avoiding trigger foods or NSAIDs when advised. Source: NHS — Stomach ulcer.
• Established Urgent assessment for alarm features: vomiting blood, black/tarry stool, unintentional weight loss, progressive swallowing difficulty, or severe sudden abdominal or chest pain. Sources: NHS — Stomach ulcer; NICE CG184.

Community insights

Anecdotal themes (not statistics):

• People often arrive after months of “indigestion” or a long NSAID habit before anyone names ulcer risk
• Night-time upper pain is a common story that finally prompts a GP visit
• Finishing an H. pylori eradication course is hard; people talk about side-effects and the need for a clear plan

Guidelines and sources