Are there any other causes of peptic ulcers?

• Smoking increases the chances of developing an ulcer and makes treatment less effective.

•Steroid drugs, such as prednisolone, are not thought to cause ulcers when taken alone, but seem to increase the risk of ulceration if taken in conjunction with NSAIDs and may be associated with ulceration caused by the condition for which the steroids themselves are prescribed.

• Diet: specific foods and beverages do not cause ulcers although some may give rise to indigestion in some people and should be avoided.

• Stress was at one time blamed for peptic ulcer, but it is no longer thought to be important, apart from the stress caused by major surgical operations or trauma.

• Inheritance of an ulcer tendency may exist in some families, but is probably more often due to H pylori passing from one family member to another than an inherited risk.

How do I know if I’ve got an ulcer?

Pain in the abdomen (belly) is the most frequent symptom. It is usually:

• Situated just below the breastbone

• Described as gnawing or knife-like, and sometimes is felt in the back.

• Lasts from a few minutes to a few hours at a time, often 1–2 hours after meals.

• It may wake you at night.

• Comes on in bouts lasting 2–3 weeks.

• Is partially relieved by antacids.

• Other symptoms associated with ulcers include heartburn, nausea and vomiting. 

Although your doctor may suspect an ulcer on the basis of what you tell them about your symptoms, the diagnosis cannot be confirmed without tests.

Many patients with an ulcer have no symptoms at all and only know about it when they develop a complication such as bleeding from the ulcer. This can result in vomiting up blood which may have a coffee-ground appearance or passing stools which are entirely black in colour.

What tests are needed?

The most accurate way of confirming a peptic ulcer is by endoscopy. This involves passing a flexible, thin tube through the mouth, down the gullet and into the stomach and duodenum.

The views obtained are so good that an ulcer can be confirmed or excluded without the need for further tests. A sample of the lining of the stomach will also be taken for microscopic examination and to check for H pylori infection.

Is there an alternative to endoscopy?

There is now good evidence that testing for H pylori, and treating it if the test is positive, is an effective alternative to an endoscopy because it is less trouble for patients and may reduce costs of treatment. The best way of testing for H pylori infection is by means of a breath test, in which you will be asked to swallow a small amount of fluid containing a trace of radioactive urea. Because H pylori splits urea in the stomach into water and carbon dioxide, a measurement of the amount of carbon dioxide in your breath is an indication of whether or not you have Helicobacter pylori infection.

Doing a blood test is a less accurate alternative to a urea breath test. Stool antigen tests, in which a small portion of a bowel motion is analysed, are also being developed as tests for H pylori infection.

Barium meals, which are x-ray procedures involving swallowing a white tasteless liquid which outlines the wall of the duodenum and stomach, are much less often used  nowadays, although sometimes, depending on your symptoms, a barium meal may be performed instead of an endoscopy.