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Gastritis and peptic ulcer: symptoms, H. pylori and endoscopy

Burning upper tummy pain? Learn how gastritis and ulcers differ, how H. pylori is tested, when an endoscopy may be needed and which warning signs need urgent care.

A burning pain in the upper tummy can have many causes. Two common ones are inflammation of the stomach lining (gastritis) and an open sore in the lining (a peptic ulcer). This guide explains the difference, the role of a germ called H. pylori, when an endoscopy may be needed, and which symptoms mean you should go to hospital straight away.

What are gastritis and peptic ulcer?

Gastritis means the lining of the stomach is inflamed. It can cause tummy pain, indigestion, bloating or fullness after eating, and nausea (feeling sick) or vomiting. Many people with gastritis have no symptoms at all.

A peptic ulcer is a sore in the lining of the stomach (a gastric ulcer) or in the first part of the small intestine, called the duodenum (a duodenal ulcer). If gastritis is not treated, it may get worse and cause a stomach ulcer.

Common symptoms

Gastritis and ulcers cause similar symptoms. Common ones are:

  • Burning or gnawing pain in the upper part of the tummy
  • Pain that often starts within a few hours of eating, or comes when the stomach is empty
  • Waking at night with pain
  • Indigestion, heartburn (a burning feeling in the chest), bloating or burping
  • Feeling full too soon during a meal
  • Nausea or vomiting

Antacids (indigestion medicines) may ease ulcer pain for a while, but the pain keeps coming back if the ulcer is not treated. Some ulcers cause no pain at all. They may only be noticed when a complication such as bleeding happens.

Tummy pain is common and can be caused by many different things, such as gallstones. Having these symptoms does not prove you have gastritis or an ulcer. Pain or indigestion that does not go away or keeps coming back should be checked by a doctor.

What causes them?

The two most common causes of peptic ulcers are:

  1. Infection with Helicobacter pylori (H. pylori), a bacterium that infects the stomach.
  2. Taking anti-inflammatory painkillers, called NSAIDs, such as aspirin, ibuprofen and naproxen. These relieve pain but make the stomach lining more likely to be damaged.

H. pylori is also the most common cause of gastritis. Other causes include NSAIDs, alcohol, serious illness or severe injury, and (less often) the immune system attacking the stomach lining. People who smoke are more likely to get peptic ulcers.

H. pylori: very common, and often silent

The US National Library of Medicine (MedlinePlus) says H. pylori affects about two-thirds of the world’s population. It is usually picked up in childhood and stays for life if it is not treated. It is not clear exactly how it spreads. It may pass through mouth-to-mouth contact, vomit, contact with stool, or contaminated food and water.

Studies have found high infection rates in Bangladesh. For example, a 2016 study from Chittagong (published in Microbiology Insights) found H. pylori in more than half of the people with indigestion that it tested. Different studies use different tests and groups of people, so treat such numbers as a rough guide.

Most people with H. pylori never have problems. According to MedlinePlus, about 10% to 15% of infected people develop a peptic ulcer. The germ can also cause long-term gastritis. Without treatment this can last a lifetime and raises the chance of stomach cancer. However, researchers have described Bangladesh as having a low stomach cancer risk despite its high infection rate.

How H. pylori is tested

  • Breath test: you swallow a special drink or capsule, then your breath is tested.
  • Stool test: checks a small sample of faeces (stool) for the germ.
  • Biopsy: a tiny piece of stomach lining is taken during an endoscopy and tested.
  • Blood antibody test: this shows whether your body has made antibodies to the germ. It can stay positive for years after the infection has gone, so it cannot tell whether you are infected now or whether treatment has worked.

Some medicines, including certain stomach medicines and antibiotics, can affect the results of H. pylori tests. Your doctor will tell you how to prepare. Tell them about every medicine you take.

When might you need an endoscopy?

An upper endoscopy (also called a gastroscopy) is a test where a thin, flexible tube with a small camera is passed through your mouth. The doctor can then look at your food pipe, stomach and the top of your intestine. It can show gastritis or an ulcer and take small samples (biopsies). It can also be used to treat some problems, such as stopping bleeding.

Not everyone with indigestion needs one. A doctor may suggest an endoscopy when:

  • Symptoms are not getting better, or are severe
  • Swallowing is difficult
  • There are signs of bleeding, such as black, sticky stool or vomiting blood
  • There are other features that need checking, such as weight loss you cannot explain, repeated vomiting, a lump in the tummy, or iron deficiency anaemia

Your doctor decides whether you need an endoscopy, based on your symptoms and history. You will usually need to stop eating at least 6 hours before the test, and you may be offered a throat-numbing spray or sedation (medicine to help you relax). The test should not be painful. Problems are rare, but can include a reaction to the sedation, some bleeding afterwards, or an infection.

How treatment generally works

Treatment depends on the cause, and your doctor will decide it. In general it may involve:

  • Medicines to heal the ulcer, such as medicines that reduce stomach acid
  • A combination of antibiotics and acid-reducing medicine if H. pylori is found. If the medicines are taken as prescribed, there is a good chance the infection will be cured. You will need another test afterwards to make sure the germ has gone.
  • Reviewing painkillers: if NSAIDs are the cause, your doctor may change your medicines. If you take aspirin, ibuprofen or similar painkillers, talk to your doctor or pharmacist about them.
  • Not smoking, as smoking makes peptic ulcers more likely

Warning signs: get urgent care

Ulcers can bleed, or can perforate (break through the wall of the stomach or gut). Both are emergencies. Go to the nearest hospital emergency department straight away if you or a family member has:

  • Vomit with bright red blood, or vomit that looks like ground coffee
  • Black, sticky, very smelly stool, or blood in the stool
  • Severe tummy pain, or a tummy that is painful to touch
  • Chest pain that started suddenly
  • Dizziness, fainting, a fast pulse, confusion, pale skin, sweating, or cold hands and feet, which can be signs of shock from blood loss

Do not drive yourself; ask someone to take you. Bring your medicines with you.

Get an urgent appointment with a doctor if you have ulcer symptoms and:

  • Your tummy pain is getting worse or will not go away
  • You have lost your appetite or feel full after very little food
  • You have lost weight without trying
  • Swallowing is painful or difficult
  • You keep vomiting
  • You feel tired all the time
  • It feels like there is a lump in your tummy

Which doctor should you see?

Situation Who to see
Mild, occasional indigestion or a first episode of upper tummy pain A general practitioner (GP) or medicine specialist (internal medicine)
Symptoms that keep coming back, do not improve with treatment, or need an endoscopy or H. pylori testing A gastroenterologist (a specialist stomach doctor; in Bangladesh often listed under gastroenterology or hepatology)
Vomiting blood, black stool, severe tummy pain Hospital emergency department; a gastroenterologist and, if needed, a general surgeon will be involved
Children with repeated tummy pain A paediatrician, who may refer to a paediatric gastroenterologist

Before your visit, write down your symptoms and how they relate to meals. Also list all your medicines, especially painkillers bought without a prescription, and any family history of ulcers, H. pylori infection or cancer of the digestive system.

Free advice by phone

The government health call centre Shasthyo Batayon (16263) lets you speak to a doctor for health advice at any time of day. You can also ask it for information about government and private hospitals. It cannot replace an emergency visit when warning signs are present.

Key points

  • Gastritis is inflammation of the stomach lining. A peptic ulcer is a sore in the stomach or duodenum.
  • H. pylori and NSAID painkillers such as aspirin and ibuprofen are the most common causes.
  • H. pylori infection is common in Bangladesh, but most people who have it never have problems.
  • An endoscopy may be advised for symptoms that do not get better or for warning signs. Your doctor decides when you need one.
  • Vomiting blood, black stool or severe tummy pain are emergencies.

Sources

This article is general information and does not replace advice from a qualified doctor.

Find a doctor

Browse Gastroenterology doctors in Bangladesh on ratings.com.bd, with chambers and, where listed, visiting hours and phone numbers.

Sources

This article is general information, not medical advice. It was written by AI from the sources above. It did not pass the automatic check, and an administrator chose to publish it; no doctor or editor has reviewed it. For a diagnosis or treatment, see a registered doctor.

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