Recurrent stomach ulcers

A peptic ulcer is a sore in the lining of the stomach or the first part of the small intestine (duodenum). Most ulcers heal well with treatment, so when ulcers recur or refuse to heal, the question is why. The commonest explanations are a persisting or untreated cause: infection with the bacterium H. pylori that was not eradicated, continued use of anti-inflammatory painkillers (NSAIDs) or aspirin, and smoking — all of which keep injuring the lining or driving acid. Not completing acid-suppressing treatment, or reinfection, also lead to recurrence. When ulcers are genuinely refractory despite these being addressed — or are multiple, unusually large, in unusual locations, or accompanied by diarrhoea — a rare but important cause is considered: Zollinger-Ellison syndrome, in which a tumour (gastrinoma) secretes the hormone gastrin uncontrollably, driving the stomach to make far too much acid. Here a fasting blood gastrin is markedly high. So recurrent ulcers are mostly about a persisting ordinary cause, but a stubborn, atypical pattern is the clue that occasionally points to this hormone-driven diagnosis. Ulcers can also bleed, which is an emergency.

• Untreated or persistent H. pylori infection — a common reason ulcers recur.
• Continued NSAIDs or aspirin — anti-inflammatory painkillers keep injuring the lining.
• Smoking — impairs healing and promotes recurrence.
• Not completing acid-suppressing treatment, or reinfection.
• Zollinger-Ellison syndrome (gastrinoma) — rare; a gastrin-secreting tumour causing severe, multiple or refractory ulcers, often with diarrhoea.
• Rarely, stomach cancer — an ulcer that does not heal needs this excluded.

Recurrent or non-healing ulcers prompt a search for a persisting cause: testing for H. pylori (and confirming it has cleared after treatment), reviewing use of NSAIDs, aspirin and smoking, and usually repeat endoscopy to reassess the ulcer and take biopsies (to exclude cancer). When ulcers are refractory, multiple, atypical, or come with diarrhoea, a fasting gastrin is measured to look for Zollinger-Ellison syndrome, interpreted alongside stomach acidity and, if raised, chromogranin A and imaging. Mediora.AI can surface a markedly raised gastrin or a positive H. pylori result from your records and flag the stubborn-ulcer pattern for review; the interpretation belongs with your doctor.