Patient information · Gastroenterology
Stomach ulcers and H. pylori
a curable infection behind most ulcers
Most stomach and duodenal ulcers are caused by a bacterium, Helicobacter pylori, or by anti-inflammatory painkillers — not by stress or spicy food. H. pylori is detected with a simple test and cured with a course of treatment, which permanently removes the cause in the great majority of people.
Call 999 or go to an emergency department if you have
- vomiting blood, or material like coffee grounds
- black, tarry, foul-smelling stools
- sudden severe abdominal pain with a rigid, board-like abdomen
- collapse, dizziness or a racing heart with abdominal pain
- persistent vomiting and inability to keep fluids down
A bleeding or perforated ulcer is a surgical emergency. Black tarry stools indicate digested blood from the upper gut and always need same-day assessment. In an emergency call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
Symptoms
- Burning or gnawing pain in the upper abdomen, often between meals or at night
- pain relieved — or sometimes worsened — by eating
- bloating, early fullness, nausea, belching and heartburn
- loss of appetite and unintentional weight loss
- Around half of people with H. pylori have no symptoms at all
Who should be tested
- anyone with persistent indigestion or upper abdominal pain
- anyone with a previous ulcer, or a family history of stomach cancer
- before starting long-term anti-inflammatories or aspirin, in some circumstances
- people with unexplained iron deficiency anaemia
- H. pylori is considerably more common in people born outside Western Europe, and infection is usually acquired in childhood
Stop acid tablets two weeks before the test
Proton pump inhibitors — omeprazole, lansoprazole and similar — suppress the bacteria without eradicating them, producing a false negative result. You must stop them for two weeks before a breath or stool test, and stop antibiotics for four weeks. This is the commonest reason a test comes back negative in someone who genuinely has the infection, and it means starting again. Ranitidine-type medicines and antacids such as Gaviscon are usually acceptable in the meantime — check with us.
Testing and treatment
- A urea breath test or stool antigen test is used — both are accurate. Blood antibody tests are not recommended, as they stay positive after successful treatment.
- Eradication therapy is a course of two antibiotics plus an acid-suppressing tablet, usually for 7 to 14 days.
- Take every dose. Missing tablets is the main cause of failure and of resistance. Side effects — metallic taste, nausea, loose stools — are common and worth pushing through.
- Avoid alcohol with certain of these antibiotics.
- A test of cure should be done at least four weeks after finishing, and eight weeks after stopping the acid tablet. This step is frequently skipped, and treatment fails in a proportion of people.
- If the first course fails, a different combination is used — not a repeat of the same one.
The other main cause
Anti-inflammatory painkillers — ibuprofen, naproxen, diclofenac and aspirin — cause ulcers by stripping the stomach's protective lining. Risk rises with age, higher doses, longer use, taking more than one, and combining them with steroids or anticoagulants. If you need them long term, you should usually be on a protective acid-suppressing tablet alongside.
When endoscopy is needed
Test-and-treat is appropriate for most people under 55 with uncomplicated indigestion. Endoscopy is indicated for anyone with difficulty swallowing, unexplained weight loss, persistent vomiting, an abdominal mass, iron deficiency anaemia, or new indigestion over the age of 55 — and urgently for anyone with signs of bleeding.
Why come to us. We can arrange H. pylori breath and stool testing with results back quickly, take bloods in-house to check for anaemia and inflammation in the same visit, prescribe eradication therapy, and — importantly — arrange the test of cure that so often never happens. Where endoscopy is indicated we refer through our CQC-registered partners without a wait. Seven days a week, no referral needed.
Tested, treated, and the cure confirmed
Bloods in-house, endoscopy arranged fast. Seven days a week.
Tower Bridge Hospital London
97–99 Whitechapel Road, London E1 1DT
WhatsApp 07903 284 189
info@mhwclinic.co.uk
Open Mon–Sat, 9am–7pm (closed Sundays until September)
In an emergency
Call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
When we are closed and it is not an emergency
Call NHS 111 or visit 111.nhs.uk.