As a pharmacist, one of the most common questions I ask when a patient comes to buy painkillers is:
“Do you have ulcer?”
Previously, the answer was often, “No o! I dey chop wella.”
But these days, the response is increasingly, “Yes” — in fact, many people (including children) now live with ulcer symptoms.
Why has peptic ulcer become so common? What causes it, and how can it be prevented or managed?
This article breaks it down.
What is Peptic Ulcer?
A peptic ulcer is a sore or wound that develops in the lining of the stomach or the first part of the small intestine (duodenum). Normally, a layer of mucus protects the stomach and intestine from strong acid used in digesting food. When this protective barrier is weakened, acid damages the lining, forming an ulcer.
Types of Peptic Ulcer
There are two main types of PUD:
- Gastric ulcer – occurs in the stomach lining.
- Duodenal ulcer – occurs in the upper small intestine.
Both cause similar symptoms, though duodenal ulcers often cause pain a few hours after meals or at night.
What Causes Peptic Ulcer Disease?
1. Helicobacter pylori (H. pylori) infection
This bacteria is the leading cause of peptic ulcer worldwide.
The stomach’s mucus lining normally shields it from acid. However, H. pylori survives by neutralising the acid around it, allowing it to dig into the stomach wall.
In response, the stomach produces even more acid. This combination of irritation and damage results in the burning pain, bloating, and nausea that many ulcer patients experience.
Over half of the world’s population carries H. pylori, but not everyone develops ulcers. For those who do, treatment is essential to prevent complications.
2. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
Painkillers like ibuprofen, diclofenac, naproxen, and aspirin are widely used. Unfortunately, long-term or frequent use is a major cause of ulcers.
Here’s why: NSAIDs block the production of prostaglandins — natural chemicals that protect the stomach by increasing mucus and blood flow. Without this protection, the stomach lining becomes vulnerable to acid, leading to irritation, bleeding, and ulcers.
This is why people with ulcers are advised to avoid NSAIDs unless prescribed under strict supervision.
Risk Factors and Triggers
Even if you don’t have H. pylori or use NSAIDs, certain habits and conditions can increase your risk or worsen an existing ulcer:
- Smoking: reduces healing ability and increases acid.
- Alcohol: irritates the stomach lining.
- Skipping meals / irregular eating: leaves the stomach exposed to acid.
- Excess caffeine and energy drinks: stimulate acid secretion.
- Chronic stress: doesn’t directly cause ulcers but worsens symptoms and slows healing.
- Other medications: corticosteroids, anticoagulants, or SSRIs, especially combined with NSAIDs.
These don’t always cause ulcers alone, but they make the stomach more vulnerable to damage.
Symptoms of Peptic Ulcer
Common symptoms include:
- Burning or gnawing stomach pain, often between meals or at night
- Pain relief after eating, followed by pain a few hours later
- Bloating, nausea, or belching
- Loss of appetite or unintended weight loss
Symptoms that signal complications (Seek help IMMEDIATELY!)
- Vomiting blood (may look like coffee grounds)
- Passing black or tarry stools
- Sudden, severe abdominal pain
- Dizziness, fainting, or weakness
Ignoring these signs can lead to life-threatening complications like bleeding ulcers or perforation (a hole in the stomach wall).
Management and Treatment
The good news: peptic ulcers are treatable.
- Test & treat H. pylori: Simply walk into a reputable pharmacy or lab for a H. pylori test. If the test is positive, you would be prescribed an ulcer kit to be taken for at least a week. This usually consists of two antibiotics and another anti-ulcer drug class called proton pump inhibitors. They stop the stomach from producing too much acid.
Note that Proton Pump Inhibitors PPIs (e.g., Omeprazole, Esomeprazole) are to be taken at least 30 minutes before food.
An antacid may also be prescribed. This should be taken when necessary, or an hour after other medications or food. - Lifestyle changes:
- Eat small, regular meals instead of a large heavy portion. Larger portions mean more acid secretion.
- Avoid alcohol, smoking, stress
- Avoid ulcer triggers (spicy foods, carbonated drinks, excess coffee)
- Don’t self-medicate with NSAIDs or caffeinated medications (eg Panadol Extra, Emcap Extra, Ibucap, etc).
- Avoid ulcer-worsening drugs: such as NSAIDs and steroids, unless absolutely necessary.
Self-medication with random “stomach drugs” is risky. Always get tested and treated properly.
Safer Painkillers for People with PUD
Since NSAIDs worsen ulcers, what alternatives exist?
- Paracetamol (acetaminophen) – usually safe for mild to moderate pain.
- Opioid-based medicines – these may be prescribed for stronger pain, but only under close medical supervision.
- Topical/local pain relief – such as creams, gels, or injections, which don’t irritate the stomach lining.
Always consult a pharmacist or doctor before choosing painkillers if you have a history of ulcer.
Final Takeaway
Peptic ulcer disease is increasingly common — but it is also preventable and treatable.
- Do not abuse painkillers.
- Do not ignore symptoms.
- Do not self-medicate without guidance.
- Pay attention to your diet, habits, and stress levels.
If you suspect you have an ulcer, consult a healthcare professional early. Timely diagnosis and treatment can save you from serious complications — and give your stomach the chance to heal.