Peptic ulcers are usually caused in one of two ways:
- H. pylori bacteria - which are responsible for 95 per cent of duodenal ulcers and 80 per cent of gastric ulcers, and
- non-steroidal anti-inflammatory drugs (NSAIDs) - which are responsible for 20 per cent of gastric ulcers, and the remaining five per cent of duodenal ulcers.
Both causes disrupt the protective effects of the mucus that lines the stomach. This disruption causes the ulcer to form which, due to the high levels of acid found in the stomach and intestines, is unable to heal naturally. This is why reducing stomach acid levels are often an important part of treatment.
H. pylori
H. pylori infections are very common, and it is often possible to be infected without realising it because the infection does not usually cause any symptoms.
However, in some cases, an H. pylori infection can cause the protective mucus that lines your stomach to become inflamed and swollen. As the sensitive wall of your stomach is no longer protected by the stomach lining, stomach acid can damage it, causing an ulcer to develop.
Duodenal ulcers (that develop in the upper part of the small intestine) can occur if an H. pylori infection is limited to the upper part of your stomach. An infection in this part of your stomach will result in an excess amount of stomach acid being produced, which flows into the duodenal area, increasing the risk of a duodenal ulcer developing.
Non-steroidal anti-inflammatory drugs (NSAIDs)
Non-steroidal anti-inflammatory drugs (NSAIDs) are medicines that are commonly used to treat:
- pain - such as toothache, headache, joint pain, and period pain,
- high temperature (fever), and
- inflammatory conditions - conditions that cause painful inflammation of the joints, such as rheumatoid arthritis.
Some people with cardiovascular disease (conditions that affect the heart and the blood) also take the NSAID aspirin on a regular basis because it can reduce the risk of blood clots.
NSAIDs usually come in tablet form, although they are also available as liquids, creams, sprays, and suppositories, which is a capsule that you insert into your rectum (back passage)..
Examples of over-the-counter (OTC) NSAIDs include:
- ibuprofen,
- aspirin, and
- naproxen.
Examples of prescription NSAIDs include:
- diclofenac,
- etodolac, and
- fenoprofen
Most of the time, NSAIDs are safe to use and do not cause any side effects. However, if NSAIDs are taken over long periods of time, they can damage the protective mucus lining in your stomach, resulting in a peptic ulcer
Due to the risk of getting peptic ulcers, it is usually recommended that you do not use NSAIDs if you currently have a peptic ulcer, or if you have had one in the past.
Other medications
Other medications (as well as NSAIDs) have been known to cause peptic ulcers in a small number of people. These include:
- corticosteroids - which are often used to treat inflammation and auto-immune conditions (conditions where the immune system attacks healthy tissue),
- bisphosphonates - used to treat osteoporosis (a condition that causes thinning and weakening of the bones),
- potassium chloride - used to treat low levels of potassium in the blood (hypokalaemia), and
- some chemotherapy medications.
