🔬 Men's Health

Peptic Ulcer Disease & H. pylori

Stomach ulcers in Nigeria — causes, treatment, and the infection behind most of them.

Peptic ulcer disease — ulcers in the stomach (gastric ulcer) or first part of the small intestine (duodenal ulcer) — is extremely common in Nigeria. The great majority are caused by Helicobacter pylori (H. pylori) infection, which affects up to 70% of Nigerians. Treating the infection cures the ulcer and prevents recurrence.

Signs and Symptoms

✓ Burning or gnawing pain in the upper abdomen — typically between meals or at night

✓ Pain that is relieved by eating or antacids (duodenal ulcer)

✓ Bloating and belching

✓ Nausea — sometimes vomiting

✓ Loss of appetite and unintentional weight loss

✓ Dark or tarry black stools — indicates bleeding ulcer (urgent)

✓ Vomiting blood (haematemesis) — emergency

✓ Sudden, severe abdominal pain — may indicate perforation (emergency)

✓ Feeling uncomfortably full after small meals

Risk Factors

H. pylori infection — the cause of 80% of duodenal ulcers and 70% of gastric ulcers
Regular NSAID use (ibuprofen, diclofenac, aspirin, naproxen) — the second most common cause
Smoking — doubles ulcer risk and reduces healing
Alcohol — damages the stomach lining
Stress — does not cause ulcers directly but worsens symptoms and healing
Blood type O — modestly increased H. pylori infection risk
Living in crowded conditions — H. pylori spreads via oral-oral or faecal-oral routes

When to Seek Help

NowBlack tarry stools, vomiting blood, or sudden severe abdominal pain — these indicate bleeding or perforation, which are medical emergencies.

SoonPersistent upper abdominal pain for more than 1–2 weeks, especially if it wakes you at night or is associated with weight loss.

SoonRegularly taking ibuprofen or other NSAIDs for pain — these should be reviewed and stomach protection considered.

RoutineKnown H. pylori infection — eradication treatment should be completed and confirmed with a breath or stool test 4 weeks after finishing treatment.

Tests & Diagnosis

🧪 Helicobacter pylori Testing

H. pylori urea breath test (most accurate, non-invasive), H. pylori stool antigen test, or H. pylori blood antibody test. Blood test cannot distinguish active from past infection — breath or stool tests preferred.

🧪 Upper GI Endoscopy (OGD)

Direct visualisation of the oesophagus, stomach, and duodenum. Detects ulcers, assesses healing, takes biopsies (to rule out stomach cancer and confirm H. pylori). Recommended for all gastric ulcers and for symptoms with alarm features.

🧪 Full Blood Count

Detects anaemia from chronic ulcer bleeding — which can be occult (invisible) and cause fatigue without obvious blood loss.

🧪 Stool Occult Blood Test

Detects small amounts of blood in stool that are invisible to the naked eye — a sign of slow ongoing bleeding.

Treatment Options

H. pylori Eradication — Triple Therapy

Standard treatment: omeprazole + amoxicillin + clarithromycin for 7–14 days. Cure rate 70–90% depending on antibiotic resistance patterns. Bismuth-based quadruple therapy is used when clarithromycin resistance is suspected.

Proton Pump Inhibitors (PPIs — Omeprazole, Pantoprazole)

Reduce acid production, allowing the ulcer to heal. Used alone for NSAID-induced ulcers when H. pylori is absent. Also used to protect the stomach when NSAIDs cannot be avoided.

Stopping NSAIDs or NSAID Protection

If NSAIDs are causing ulcers, switching to paracetamol for pain relief is preferred. If NSAIDs are medically necessary, a PPI must be co-prescribed to protect the stomach.

Lifestyle Modifications

Stop smoking — ulcers heal much faster and recur much less in non-smokers. Limit or avoid alcohol. Eat smaller, more frequent meals. Avoid trigger foods (very spicy, very acidic) during healing.

Confirm Eradication

A urea breath test or stool antigen test 4 weeks after completing H. pylori treatment confirms eradication. This step is frequently skipped in Nigeria — leaving 10–30% of people incompletely treated.

Frequently Asked Questions

Does eating pepper or spicy food cause ulcers?

No. H. pylori bacteria and NSAIDs are the primary causes. Spicy food can irritate an existing ulcer and worsen symptoms, but it does not cause the ulcer in the first place.

Can ulcers be cured permanently?

Yes — when caused by H. pylori, successful eradication cures the ulcer and prevents recurrence. Gastric ulcers require endoscopic confirmation of healing to rule out gastric cancer.

Is H. pylori infection contagious?

H. pylori spreads through person-to-person contact, contaminated food, water, and poor sanitation. It is very common in Nigeria — most people are infected in childhood. Having H. pylori does not mean you did anything wrong.

Do I need an endoscopy for stomach pain?

Not always. For most people under 55 with typical ulcer symptoms and no alarm features, testing for H. pylori and treating if positive is appropriate first. Endoscopy is recommended for alarm features (weight loss, dysphagia, anaemia, older age, previous ulcer), gastric ulcers (to rule out cancer), and lack of response to treatment.

How long does treatment take to work?

Symptoms often improve within the first week of treatment. Full healing of a duodenal ulcer typically takes 4–8 weeks; gastric ulcers 8–12 weeks. Complete the full antibiotic course even if feeling better earlier.