COMMON STOMACH AND BOWEL PROBLEMS
GASTRITIS & PEPTIC ULCERS
About stomach ulcers
Gastritis is inflammation to wall of your stomach. Stomach ulcers (gastric ulcers) are open sores that develop on the lining of the stomach. Ulcers can also occur in part of the intestine just beyond the stomach. These are called duodenal ulcers.
Stomach and duodenal ulcers are sometimes called peptic ulcers. This information applies to both.
Symptoms of stomach ulcers
Although the most common symptom of a stomach ulcer is a burning or gnawing pain in the centre of the abdomen (tummy). Not all stomach ulcers are painful.
Some people experience:
nausea (feeling sick)
Get urgent medical advice
Speak to your GP immediately (or phone the 911 service) if:
your symptoms persist
you're vomiting blood – the blood can appear bright red or have a dark brown, grainy appearance like coffee grounds
you're passing dark, sticky, tar-like stools
you feel a sudden, sharp pain in your tummy that gets steadily worse
These could be a sign of a serious complication.
What causes stomach ulcers?
Stomach ulcers occur when the layer protecting the stomach lining from stomach acid breaks down. This allows the stomach lining to become damaged.
This is usually caused by:
an infection with Helicobacter pylori (H. pylori) bacteria
taking non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or aspirin – particularly if they're taken for a long time or at high doses
There's little evidence that stress or certain foods causes stomach ulcers.
More about the causes of stomach ulcers
Treating stomach ulcers
You'll be treated using antibiotics if your ulcer was caused by a H. pylori infection. This kills the bacteria and should prevent the ulcer coming back.
You'll be treated using a proton pump inhibitor (PPI) if your ulcer was caused by NSAIDs. Your doctor will prescribe these and discuss whether you should keep using NSAIDs. Alternative medication to NSAIDs, such as paracetamol, may be recommended.
Most stomach ulcers take a few months to heal after treatment. However, stomach ulcers can come back after treatment, although this is less likely to happen if the underlying cause is addressed.
Complications are rare but can be very serious and potentially life-threatening.
The main complications include:
bleeding at the site of the ulcer
the stomach lining at the site of the ulcer splits open – known as perforation
the ulcer blocks the movement of food through the digestive system – known as gastric obstruction
About gastro-esophageal reflux disease (GERD)
Gastro-esophageal reflux disease (GERD) is a common condition, where acid from the stomach leaks up into the esophagus (gullet).
It usually occurs as a result of the ring of muscle at the bottom of the esophagus becoming weakened.
GERD causes symptoms such as heartburn and an unpleasant taste in the back of the mouth. It may just be an occasional nuisance for some people, but for others it can be a severe, lifelong problem.
GERD can often be controlled with self-help measures and medication. Occasionally, surgery to correct the problem may be needed.
This topic focuses on GERD in adults.
Symptoms of GERD
Symptoms of GERD can include:
heartburn (an uncomfortable burning sensation in the chest that often occurs after eating)
acid reflux (where stomach acid comes back up into your mouth and causes an unpleasant, sour taste)
esophagitis (a sore, inflamed esophagus)
bloating and belching
feeling or being sick
pain when swallowing and/or difficulty swallowing
What to do if you have GERD
You can often control the symptoms of GERD by making some lifestyle changes and taking over-the-counter medication.
You don't necessarily need to see your GP if you only have symptoms occasionally. Ask your pharmacist for advice on treatments.
When to see your GP
Visit your GP if you're worried about your symptoms, or if:
you have symptoms several times a week
over-the-counter medications aren't helping
your symptoms are severe
you have difficulty swallowing
you have possible signs of a more serious problem, such as persistent vomiting, vomiting blood or unexplained weight loss
Your GP will usually be able to diagnose GERD based on your symptoms, although they may refer you for some tests.
Treatments for GERD
The main treatments for GERD are:
self-help measures – this includes eating smaller but more frequent meals, avoiding any foods or drinks that trigger your symptoms, raising the head of your bed, and keeping to a healthy weight
over-the-counter medicines – ask your pharmacist to recommend an antacid or an alginate
stronger prescription medicines – including proton-pump inhibitors (PPIs) and H2-receptor antagonists (H2RAs)
You may only need to take medication when you experience symptoms, although long-term treatment may be needed if the problem continues.
Surgery to stop stomach acid leaking into your esophagus may be recommended if medication isn't helping, or you don't want to take medication on a long-term basis.
Complications of GERD
If you have GERD for a long time, stomach acid can damage your esophagus and cause further problems.
ulcers (sores) on the esophagus – these may bleed and make swallowing painful
the esophagus becoming scarred and narrowed – this can make swallowing difficult and may require an operation to correct it
changes in the cells lining the esophagus (Barrett's esophagus) – very occasionally, Esophageal cancer can develop from these cells, so you may need to be closely monitored
About ulcerative colitis
Ulcerative colitis is a long-term condition, where the colon and rectum become inflamed.
The colon is the large intestine (bowel), and the rectum is the end of the bowel where stools are stored.
Small ulcers can develop on the colon's lining, and can bleed and produce pus.
Symptoms of ulcerative colitis
The main symptoms of ulcerative colitis are:
recurring diarrhea, which may contain blood, mucus or pus
abdominal (tummy) pain
needing to empty your bowels frequently
You may also experience fatigue (extreme tiredness), loss of appetite and weight loss.
The severity of the symptoms varies, depending on how much of the rectum and colon is inflamed and how severe the inflammation is. For some people, the condition has a significant impact on their everyday lives.
Symptoms of a flare-up
Some people may go for weeks or months with very mild symptoms, or none at all (known as remission), followed by periods where the symptoms are particularly troublesome (known as flare-ups or relapses).
During a flare-up, some people with ulcerative colitis also experience symptoms elsewhere in their body. For example, some people develop:
painful and swollen joints (arthritis)
areas of painful, red and swollen skin
irritated and red eyes
In severe cases, defined as having to empty your bowels 6 or more times a day, additional symptoms may include:
shortness of breath
a fast or irregular heartbeat
a high temperature (fever)
blood in your stools becoming more obvious
In most people, no specific trigger for flare-ups is identified, although a gut infection can occasionally be the cause. Stress is also thought to be a potential factor.
Read more about living with ulcerative colitis.
When to seek medical advice
You should see your GP as soon as possible if you have symptoms of ulcerative colitis and you haven't been diagnosed with the condition.
They can arrange blood or stool sample tests to help determine what may be causing your symptoms. If necessary, they can refer you to hospital for further tests.
Read more about diagnosing ulcerative colitis.
If you've been diagnosed with ulcerative colitis and think you may be having a severe flare-up, contact your GP or care team for advice. You may need to be admitted to hospital.
If you can't contact your GP or care team, call NHS 24 111 service or contact your local out-of-hours service.
What causes ulcerative colitis?
Ulcerative colitis is thought to be an autoimmune condition. This means the immune system – the body's defence against infection – goes wrong and attacks healthy tissue.
The most popular theory is that the immune system mistakes harmless bacteria inside the colon for a threat and attacks the tissues of the colon, causing it to become inflamed.
Exactly what causes the immune system to behave in this way is unclear. Most experts think it's a combination of genetic and environmental factors.
Read more about the causes of ulcerative colitis.
It's estimated that around 1 in every 420 people living in the UK has ulcerative colitis; this amounts to around 146,000 people.
The condition can develop at any age, but is most often diagnosed in people from 15 to 25 years old.
It's more common in white people of European descent (especially those descended from Ashkenazi Jewish communities) and black people. The condition is rarer in people from Asian backgrounds (although the reasons for this are unclear).
Both men and women seem to be equally affected by ulcerative colitis.
How ulcerative colitis is treated
Treatment for ulcerative colitis aims to relieve symptoms during a flare-up and prevent symptoms from returning (known as maintaining remission).
In most people, this is achieved by taking medication such as:
Mild to moderate flare-ups can usually be treated at home. However, more severe flare-ups need to be treated in hospital to reduce the risk of serious complications, such as the colon becoming stretched and enlarged or developing large ulcers. Both of these can increase the risk of developing a hole in the bowel.
If medications aren't effective at controlling your symptoms, or your quality of life is significantly affected by your condition, surgery to remove your colon may be an option.
During surgery, your small intestine will either be diverted out of an opening in your abdomen (known as an ileostomy), or used to create an internal pouch that's connected to your anus (known as an ileo-anal pouch).
Read more about:
treating ulcerative colitis
complications of ulcerative colitis
H. PYLORI & STOMACH CANCER
About stomach cancer
Stomach cancer, or gastric cancer, is a fairly uncommon type of cancer. Around 7,000 people are diagnosed with it each year in the UK.
The initial symptoms of stomach cancer are vague and easy to mistake for other less serious conditions. They include:
persistent indigestion and heartburn
trapped wind and frequent burping
feeling very full or bloated after meals
persistent stomach pain
Symptoms of advanced stomach cancer can include:
blood in your stools, or black stools
loss of appetite
As the early symptoms of stomach cancer are similar to those of many other conditions, the cancer is often advanced by the time it's diagnosed. It's therefore important to get any possible symptoms of stomach cancer checked by your GP as soon as possible.
Read more about diagnosing stomach cancer
The exact cause of stomach cancer is still unclear, although you're more likely to develop it if you:
are 55 years of age or older
have a diet low in fibre and high in processed food or red meat
have a diet that contains a lot of salted and pickled foods
have a stomach infection caused by Helicobacter pylori (H. pylori) bacteria
Types of stomach cancer
There are several different types of stomach cancer. More than 95% of stomach cancers develop in the cells of the stomach lining and are known as adenocarcinomas.
Less common types of stomach cancer include lymphoma of the stomach, which develops in the lymphatic tissue (tissue that drains away fluid and helps fight infection), and gastrointestinal stromal tumours (GISTs), which develop in the muscle or connective tissue of the stomach wall.
How stomach cancer is treated
Many cases of stomach cancer can't be completely cured, but it's still possible to relieve symptoms and improve quality of life using chemotherapy and in some cases radiotherapy and surgery.
If operable, surgery can cure stomach cancer as long as all of the cancerous tissue can be removed.
Surgery to remove some or all of the stomach is known as a gastrectomy. It will still be possible to eat normally after a gastrectomy, but you'll probably have to adjust the size of your portions.
Chemotherapy can also be used before surgery to help shrink the tumour and sometimes after surgery to help prevent the cancer returning.
Living with stomach cancer
Living with stomach cancer and the effects of surgery can be tough, but there are a range of services that can provide social, psychological and financial support.
The outlook for stomach cancer depends on several factors, including your age, your general health, and how far the cancer has spread (the stage of the condition).
Unfortunately, as stomach cancer isn't often picked up until the later stages, the outlook isn't as good as for some other cancers. Of all those with stomach cancer, about:
42 out of 100 people (42%) will live for at least 1 year after diagnosis
19 out of 100 people (19%) will live for at least 5 years after diagnosis
15 out of every 100 people (15%) will live for at least 10 years after diagnosis
About bowel cancer
Bowel cancer is a general term for cancer that begins in the large bowel. Depending on where the cancer starts, bowel cancer is sometimes called colon or rectal cancer.
Cancer can sometimes start in the small bowel (small intestine), but small bowel cancer is much rarer than large bowel cancer.
Bowel cancer is one of the most common types of cancer diagnosed in the UK, with around 40,000 new cases diagnosed every year.
About 1 in every 20 people in the UK will develop bowel cancer in their lifetime.
Signs and symptoms
The three main symptoms of bowel cancer are blood in the stools (faeces), changes in bowel habit – such as more frequent, looser stools – and abdominal (tummy) pain.
However, these symptoms are very common and most people with them do not have bowel cancer. For example, blood in the stools is more often caused by haemorrhoids (piles), and a change in bowel habit or abdominal pain is usually the result of something you have eaten.
As almost 9 out of 10 people with bowel cancer are over the age of 60, these symptoms are more important as people get older. They are also more significant when they persist despite simple treatments.
Most people who are eventually diagnosed with bowel cancer have one of the following combinations of symptoms:
a persistent change in bowel habit that causes them to go to the toilet more often and pass looser stools, usually together with blood on or in their stools
a persistent change in bowel habit without blood in their stools, but with abdominal pain
blood in the stools without other haemorrhoid symptoms, such as soreness, discomfort, pain, itching or a lump hanging down outside the back passage
abdominal pain, discomfort or bloating always provoked by eating, sometimes resulting in a reduction in the amount of food eaten and weight loss
The symptoms of bowel cancer can be subtle and don't necessarily make you feel ill.
When to seek medical advice
Read about the symptoms of bowel cancer, and when you should see your GP to discuss whether any tests are necessary.
Your doctor will probably carry out a simple examination of your tummy and bottom to make sure you have no lumps.
They may also arrange for a simple blood test to check for iron deficiency anaemia – this can indicate whether there is any bleeding from your bowel that you haven't been aware of.
In some cases, your doctor may decide it is best for you to have a simple test in hospital to make sure there is no serious cause for your symptoms.
Make sure you return to your doctor if your symptoms persist or keep coming back after stopping treatment, regardless of their severity or your age.
Read more about diagnosing bowel cancer
Who's at risk?
It's not known exactly what causes bowel cancer, but there are a number of things that can increase your risk. These include:
age – almost 9 in 10 cases of bowel cancer occur in people aged 60 or over
diet – a diet high in red or processed meats and low in fibre can increase your risk
weight – bowel cancer is more common in people who are overweight or obese
exercise – being inactive increases the risk of getting bowel cancer
alcohol and smoking – a high alcohol intake and smoking may increase your chances of getting bowel cancer
family history – having a close relative (mother or father, brother or sister) who developed bowel cancer under the age of 50 puts you at a greater lifetime risk of developing the condition
Some people have an increased risk of bowel cancer because they have another condition that affects their bowel, such as severe ulcerative colitis or Crohn's disease, over a long period of time.
Read more about the causes of bowel cancer and preventing bowel cancer
Bowel cancer screening
Bowel screening is offered to men and women aged 50 to 74 across Scotland to help find bowel cancer early when it can often be cured.
Bowel screening involves taking a simple test at home every 2 years. The test looks for hidden blood in your poo, as this could mean a higher chance of bowel cancer.
Read more about screening for bowel cancer
Treatment and outlook
Bowel cancer can be treated using a combination of different treatments, depending on where the cancer is in your bowel and how far it has spread.
The main treatments are:
surgery – the cancerous section of bowel is removed; it is the most effective way of curing bowel cancer, and is all that many people need
chemotherapy – where medication is used to kill cancer cells
radiotherapy – where radiation is used to kill cancer cells
biological treatments – a newer type of medication that increases the effectiveness of chemotherapy and prevents the cancer spreading
As with most types of cancer, the chances of a complete cure depends on how far it has advanced by the time it is diagnosed. If the cancer is confined to the bowel, surgery will usually be able to completely remove it.
Overall, 7 to 8 in every 10 people with bowel cancer will live at least one year after diagnosis. More than half of those diagnosed will live at least another 10 years. Every year, around 16,000 people die as a result of bowel cancer.