🫁 Men's Health

Peptic Ulcer & H. pylori in Nigeria

Q: Is it safe to take ibuprofen with a stomach ulcer?

No — NSAIDs like ibuprofen directly damage the stomach lining and prevent ulcer healing. Use paracetamol for pain instead. If NSAIDs are essential, always take them with a PPI (omeprazole).

Q: How common is peptic ulcer in Nigeria?

Very common — H. pylori infection rates exceed 80% in most Nigerian communities, meaning peptic ulcer is one of the most frequent GI conditions seen by Nigerian doctors.

Understanding stomach ulcers and eradicating H. pylori infection

Peptic ulcers are open sores in the lining of the stomach or duodenum (first part of the small intestine). In Nigeria, over 80% of peptic ulcers are caused by Helicobacter pylori (H. pylori) infection — a bacterium that is extremely prevalent in Nigerian communities, often acquired in childhood. NSAIDs (painkillers like ibuprofen, diclofenac) are the second major cause. Ulcers are highly treatable with the right antibiotic combination.

Signs and Symptoms

✓ Burning or gnawing pain in the upper-central abdomen, often worse 1–3 hours after eating or at night

✓ Relief with food or antacids (duodenal ulcer) or worsening after food (gastric ulcer)

✓ Bloating, belching, nausea, and feeling full quickly

✓ Loss of appetite and weight loss

✓ Dark tarry stools (melaena) — indicates bleeding ulcer, requires urgent attention

✓ Vomiting blood (haematemesis) — emergency

Risk Factors

H. pylori infection: affects >80% of Nigerians with peptic ulcer disease; spread through contaminated food, water, and close contact
Regular NSAID use (ibuprofen, aspirin, diclofenac, piroxicam) — damages the stomach lining protective layer
Smoking: doubles ulcer risk and reduces healing
Alcohol in large quantities
Stress: does not cause ulcers but worsens symptoms
Family history of peptic ulcer disease

When to Seek Help

EmergencyVomiting blood (even small amount), passing black tarry stools, sudden severe abdominal pain that does not go away (perforation) — go to A&E immediately

UrgentUnintentional weight loss with ulcer symptoms, difficulty swallowing, recurrent vomiting — need endoscopy to exclude cancer

RoutineTypical burning upper abdominal pain especially waking at night or 2 hours after food — investigate and treat; do not just take antacids long-term without diagnosis

Tests & Diagnosis

🧪 H. pylori urea breath test

Gold standard non-invasive test — patient drinks solution and breathes into collection bag; 95% accurate; stop proton pump inhibitors (PPIs) 2 weeks before test

🧪 H. pylori stool antigen test

Accurate and widely available in Nigeria; also used to confirm eradication 4 weeks after treatment

🧪 H. pylori serology (blood antibody)

Widely available but cannot distinguish active from past infection — less useful for treatment monitoring

🧪 Upper GI endoscopy (OGD)

Gastroscope passed through mouth to directly view stomach and duodenum; biopsy confirms H. pylori and excludes cancer; essential if alarm symptoms present

🧪 Full blood count

To check for iron deficiency anaemia from chronic slow bleeding

Treatment Options

Triple therapy eradication

Standard first-line: omeprazole 20mg + amoxicillin 1g + clarithromycin 500mg — all twice daily for 14 days; cure rate 85–90%

Quadruple therapy (if clarithromycin resistance suspected)

Omeprazole + bismuth + tetracycline + metronidazole for 14 days — used where clarithromycin resistance is common

Proton pump inhibitor (PPI) continuation

Omeprazole or pantoprazole for 4–8 weeks total after antibiotics to allow ulcer healing

Confirm eradication

H. pylori stool antigen or breath test 4 weeks after completing antibiotics — do not stop here without confirming cure

Stop NSAIDs

If NSAID-related ulcer — stop or switch to a COX-2 selective NSAID (celecoxib) + PPI cover; never take NSAIDs on an empty stomach

Lifestyle

Avoid smoking, reduce alcohol, avoid eating just before bed, raise bed head for night symptoms

Frequently Asked Questions

Is H. pylori curable?

Yes — with the correct antibiotic combination, H. pylori is cured in >85% of cases. It is critical to complete the full 14-day course even if symptoms improve.

Can ulcers become cancer?

H. pylori-associated gastric ulcers (stomach ulcers, not duodenal) carry a small risk of progressing to stomach cancer if untreated. Eradication of H. pylori significantly reduces this risk.

Will the ulcer come back after treatment?

After confirmed H. pylori eradication, recurrence is rare (<5% per year). Without eradication treatment, ulcers recur in 60–80% within one year.

Is it safe to take ibuprofen with a stomach ulcer?