Peptic Ulcer Disease

What is peptic ulcer disease?

Peptic ulcer disease refers to the development of sores (ulcers) in the lining of the stomach or the upper part of the small intestine (duodenum). These ulcers form when the protective lining is weakened, allowing stomach acid to damage the tissue beneath.

There are two main types:

  • Gastric ulcers – occurring in the stomach

  • Duodenal ulcers – occurring in the first part of the small intestine (duodenum)

What causes peptic ulcers?

The most common causes include:

  • Helicobacter pylori (H. pylori) infection – a type of bacteria that disrupts the stomach’s protective lining

  • Non-steroidal anti-inflammatory drugs (NSAIDs) – such as ibuprofen and aspirin, which can irritate or damage the stomach lining

Other contributing factors:

  • Smoking

  • Excessive alcohol use

  • Physiological stress or acute illness

  • Rare conditions such as Zollinger–Ellison syndrome, which causes excessive acid production

What are the symptoms of a peptic ulcer?

Typical symptoms may include:

  • Pain or discomfort in the upper abdomen

    • Gastric ulcers often worsen after eating

    • Duodenal ulcers may feel better initially after eating but worsen later

  • Nausea or vomiting

  • Bloating or early fullness

  • Loss of appetite

  • Unintentional weight loss

More serious symptoms may indicate a complication:

  • Bleeding: Vomiting blood (bright red or coffee-ground appearance), or passing black, tarry stools

  • Perforation: Sudden, severe abdominal pain due to the ulcer eroding through the stomach or duodenal wall

  • Gastric outlet obstruction: blockage to exit of the stomach leading to persistent vomiting, inability to eat and drink and weight loss

How is peptic ulcer disease diagnosed?

Diagnosis may include:

  • Blood tests – to check haemoglobin levels and iron stores (which may be low in cases of bleeding)

  • Gastroscopy (upper endoscopy): A camera is used to directly visualise the ulcer and take tissue biopsies. If evidence of bleeding, this can usually be treated during the procedure

  • H. pylori testing – via breath test, stool test, or biopsy taken during endoscopy

How is peptic ulcer disease treated?

Lifestyle and dietary changes:

  • Avoid NSAIDs where possible

  • Quit smoking and limit alcohol to recommended levels

  • Avoid foods and drinks that may aggravate symptoms, such as spicy or acidic foods, and caffeine

Medications:

  • Proton pump inhibitors (PPIs): These reduce acid production and promote ulcer healing

    • Examples: esomeprazole, omeprazole, pantoprazole and rabeprazole

  • H. pylori eradication therapy: If infection is present, treatment typically includes a combination of antibiotics and a PPI, taken for 1–2 weeks

  • Antacids, sucralfate or H2-receptor antagonists: These are occasionally used to provide symptom relief

Surgery:

  • Surgery may be needed in rare cases where complications occur, such as a perforated ulcer or bleeding that cannot be controlled with endoscopic or radiological treatments