How are Ulcers Formed from Drinking Alcohol?

In essence, ulcers are sores that appear on the lining of the stomach, oesophagus or the duodenum (which is part of the small intestine) that tends to develop when the protective layer of membrane that lines the stomach becomes damaged and is exposed to the stomach acid.

All ulcers are similar in nature but named differently depending on their location with gastric ulcers located in the stomach, duodenal ulcers appearing in the small intestine and oesophagus ulcers appearing in the lower section of the oesophagus close to the stomach.

Both gastric (stomach) ulcers and duodenal ulcers produce the same symptoms, and the treatment is usually the same for both types of ulcers.

Ulcers are very painful and so are difficult to ignore if you have them and, if left untreated can lead to further complications, which can be life-threatening.  (2,4)

Signs and symptoms of stomach ulcers

• A burning pain or gnawing discomfort in the abdomen area.
• You may notice blood in stools or vomit.
• Heartburn/indigestion and acid reflux.
• A decline in appetite.
• Weight loss.

What causes stomach ulcers?

According to the medical community, it is not always clear what exactly causes ulcers as there are potentially many factors that could lead to the condition and the causes may differ from person to person depending on a variety of factors.

There are therefore different views on what causes ulcers although scientists do make the distinction between what directly causes an ulcer and what factors make an existing ulcer worse.

There are, according to some medical professionals three main reasons lead to the development of ulcers, these are:

• Long-term use of medications such as ibuprofen and aspirin which are both used for pain relief, these medications are both classed as non-steroidal drugs which have an anti-inflammatory effect.
• Cancerous tumours in the stomach or pancreas.
• The main cause of ulcers however according to many doctors is a consequence of a bacterial infection called H. Pylori which damages the protective membrane around the stomach which irritates the lining underneath and causes the ulcer. (2,4)

An alternative view of how ulcers develop

However, some medical experts have an opposing view and believe that a combination of stress and dehydration causes stomach ulcers, as people who do not drink a sufficient amount of water each day are at risk of developing ulcers.

This is because water plays an important role in ensuring that the layer of mucus protecting the stomach lining is strong enough to keep out harmful stomach acids. (1,4)

Incorrect assumptions

It is commonly believed by many people that spicy foods, stress and high alcohol intake can cause ulcers, however, many medical practitioners appear to feel that this is an inaccurate belief and it is more likely that alcohol and spicy foods aggravate existing ulcers rather than cause ulcers.

What is certain is that alcohol has a very toxic effect on most organs in the human body and people who drink heavily are placing their health at risk. (1,3)

Are stomach ulcers dangerous?

Stomach ulcers are very painful and uncomfortable but they are only dangerous if they are left untreated as the ulcers may progress and lead to more serious complications, which include; (4)

Internal bleeding

The most common complication that occurs with a stomach ulcer is gastrointestinal bleeding, which occurs when an ulcer develops within close proximity of a blood vessel.

Bleeding can be at a slow or fast rate, with slow bleeding ulcers developing gradually causing damage over the long term which leads to the patient becoming anaemic and experiencing fatigue and shortness of breath.

Fast-rate bleeding ulcers will usually result in the patient vomiting blood. This is a sign that they need to undergo surgery to cease the bleeding, and when more serious complications arise, the surgical team may have to give the patient a blood transfusion to replenish all the blood they have lost. (3,4)

Perforation

This occurs when the ulcer eats into the stomach wall and causes the ulcer to burst open, causing further complications which could mean the patient may require surgery as the condition is now perceived as life-threatening because the stomach lining is now exposed to bacteria and the patient is at risk of developing peritonitis. (3,4)

Toxic effects of alcohol

The toxic effects of alcohol have been commonly known for some time and high alcohol intake is still identified by national institutions (NHS) and world organisations (WHO) as being responsible for a large number of deaths and illnesses worldwide. (8)

Because alcohol contains highly diffusible properties it can pass easily between many cells, tissues and organs in the human body and cause physical damage as most tissues in the body can metabolise alcohol efficiently.

The gastrointestinal system has been acknowledged as the system in the body which suffers most at the hands of the harmful chemicals in alcohol, with the cardiovascular system second.

Drinking too much alcohol does appear to erode the gastrointestinal mucosal barrier which is responsible for containing the acidic contents of the stomach and preventing it from causing harm to surrounding areas of the body meaning that the individual is more vulnerable to developing ulcers. (6)

Alcohol and hydration

Alcohol has a diuretic effect on the human body which means it leads to water loss by stimulating a need to urinate more often.

The consequence of this is that heavy alcohol use will lead to the drinker becoming more dehydrated which can have several debilitating consequences on the human body as being dehydrated will affect many aspects of our internal physiology and cause a decline in the efficiency of several biological processes and damage to key organs.

This will lead to us feeling tired, weak and more vulnerable to illnesses and infections.

When the body is not sufficiently hydrated this can make an individual more vulnerable to developing stomach ulcers as published scientific research suggests when the body is in a state of dehydration this provides the ideal internal physiological climate for ulcers to develop. (1,5)

Alcohol and stomach problems

Anyone who experiences stomach pain during or after drinking alcohol should realise that this is a sign that something is wrong in their abdominal area which needs looking at as there is a high probability that they have a stomach ulcer.

If a person experiences mild discomfort each time they drink alcohol then they should book an appointment with their GP as the discomfort caused by an ulcer will not go away unless they stop drinking.

Ulcers will continue to be aggravated by regular alcohol intake if the patient does not stop drinking and eventually the pain levels will increase because the ulcers are getting worse and not healing.

If a person does stop drinking then the pain may go away or be reduced in intensity although it is still a good idea to consult with your GP. (4,6)

The effects of heavy alcohol use

If the protective stomach lining is constantly irritated by large volumes of alcohol eventually heavy drinkers will find that over time their stomach lining will become red and raw and eventually inflamed.

If they do not stop drinking alcohol, at least temporarily then there is an increased risk of bleeding as the open sores/ulcers become more severe.

It is also possible to have both gastric (stomach) and duodenal ulcers at the same time which can certainly be exacerbated by continued alcohol use and places the individual at an even greater risk of experiencing further complications.

Risk factors for developing ulcers

While it is not clear that alcohol itself directly causes stomach ulcers it is certainly a significant risk factor that can predispose heavy drinkers to develop ulcers if there are other factors co-existing alongside their heavy alcohol use.

Many heavy drinkers do smoke cigarettes as well and a strong correlation has been found between smoking and high alcohol intake, with some findings suggesting that over 85% of individuals who are dependent on alcohol smoke regularly as well.

Nicotine also tends to irritate the stomach lining and also increases the production of stomach acid, which significantly raises the risk of developing an ulcer. (4,7)

Other risk factors for developing ulcers include:

• Regularly taking nonsteroidal anti-inflammatory drugs, including Ibuprofen, either for a long time or consuming high doses in the short term.
• People aged over 65.
• Females are more at risk than males.
• People who are not adequately hydrated (those who drink less than 2 litres of water each day).
• People who suffer from underlying medical conditions are at greater risk.
• Individuals who consistently eat a lot of spicy foods.
• Poor diet with lack of adequate nutrition.
• People who have a lot of ongoing stress in their lives.
• Liver, kidney or lung disease.
• A family history of ulcers.

The more of the above risk factors that are relevant to an individual the higher the probability that they will develop an ulcer.

Drinking alcohol when you have been diagnosed with a stomach ulcer can disrupt the healing process, this is particularly dangerous for individuals diagnosed with a stomach ulcer who are not in much pain (or any pain at all). (2,5)

How will I know if alcohol is making my ulcer worse?

If you have already been diagnosed with a stomach ulcer and carry on drinking alcohol you will eventually experience the following symptoms which indicate that your condition is deteriorating further:

• Feeling weak and even fainting.
• Your breathing becomes more laboured.
• Sharp, sudden pain in the abdominal area.
• You may notice blood in your vomit.
• Blood may be noticeable in your stools.
• You may suffer from heartburn and acid reflux which can slowly damage your oesophagus.
• There may be changes to your weight and your appetite may fluctuate. (1,2,5)

How much alcohol is considered excessive?

If you are vulnerable to developing stomach ulcers because one or more of the risk factors identified apply to you, then drinking more than the weekly recommended amount of 14 units would increase your risk of developing a stomach ulcer.

The more risk factors that apply to you the greater vulnerability you have to suffer from an ulcer.

Medical research has indicated that because of the toxic effects of alcohol people should not regularly drink more than the recommended 14 units of alcohol per week as it could lead to a deterioration in several aspects of their health over the long term. One of the areas likely to be affected is the stomach and digestive system.

The weekly safe drinking level of 14 units is equivalent to:

• 5 pints of beer @ 5.2 % (1 pint is 3 units).
• 7 pints of @ 4% beer (1 pint is 2 units).
• 14 single measures of any spirit @40% (1 unit per measure).
• 7 standard (175ml) glasses of wine @12% strength (1 glass is 2 units).
• 5 large (250ml) glasses of wine @ 12% strength (1 glass is 3units).
• One and a half bottles of wine (12% strength).

Consequences of Heavy drinking

Even though there is uncertainty in the medical community that alcohol directly causes stomach ulcers it certainly makes the symptoms worse for people that have already been diagnosed with an ulcer and will generate a few more problematic symptoms as well, including:

• Persistently irritating the stomach lining will not only cause several ulcers to appear but increase the probability that further complications will arise.
• Permanent wounds in the stomach lining.
• Frequent bouts of inflammation that can cause discomfort, which may subside temporarily but will never disappear.
• More susceptible to gastrointestinal bleeding.
• The stomach muscles and tissues will shrink and weaken, and become less effective causing a range of problems as your digestive system will not be able to function as well as it previously did. (6)

Stopping alcohol consumption allows ulcers to heal

If your digestive health is not improving because you are drinking alcohol and not allowing your ulcers to heal then it is important to give up alcohol before the health consequences you suffer will become more severe.

If you find it hard to do this then it is important to speak to your GP about having alcohol rehab treatment before your health deteriorates even further and you may require surgery and/or have long-term health problems that will reduce your quality of life.

The role of alcohol misuse treatment

If you are unable to stop drinking alcohol after being told by your doctor to stop then you need to consider the possibility that you may have alcohol use disorder (alcohol addiction).

Having this diagnosis confirmed will enable you to access specialist treatment to help you give up drinking which will help prevent you from coming to further physical harm as a result of your excessive alcohol consumption.

Residential rehab would be the preferred option

If it is essential for a patient to give up alcohol to ensure that the significant threat to their health is reduced then they would be best served by agreeing to receive treatment on an inpatient basis.

This will allow them to be monitored and looked after around the clock and all the temptations to drink alcohol from their usual environment are removed during their 4-6 week stay at a residential setting.

Treatment staff can then organise alcohol detox treatment to tackle their physical dependence, and a range of psychological therapies to address the emotional reasons behind their psychological dependence on alcohol, which has become so entrenched it is causing them significant physical damage which will be life-threatening if not treated.

References

(1) APEC Water (2022) Dehydration: Is it a cause of peptic ulcers? Available@Water Health – Dehydration: Is It a Cause of Peptic Ulcers? | APEC Water (freedrinkingwater.com)

(2) Christensen, S. et al (2007) Short-term mortality after perforated or bleeding peptic ulcer among elderly patients: A population-based cohort study. available@ Short-term mortality after perforated or bleeding peptic ulcer among elderly patients: a population-based cohort study – PMC (nih.gov)

(3) Chung, K.T, & Shelat, V.G. (2017) Perforated Peptic Ulcer: An update. available@ Perforated peptic ulcer – an update – PMC (nih.gov)

(4) NHS (2022) Stomach Ulcer: Complications. available@Stomach ulcer – Complications – NHS (www.nhs.uk)

(5) Northern Care Alliance NHS (2022) Diuretics: An Information guide. available@505 – Diuretics.pdf (pat.nhs.uk)

(6) Rusyn, I. & Bataller, R, (2013) Alcohol and toxicity. available@ALCOHOL AND TOXICITY – PMC (nih.gov)

(7) Thorburn, D. (2004) How to Spot Hidden Alcoholics: using Behavioural Clues to Recognise Addiction in its Early stages. Galt publishing.

(8) World Health Organisation (2022) Alcohol. available@Alcohol (who.int)

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