Peptic ulcer disease
Also called: Stomach ulcer, Duodenal ulcer, Gastric ulcer
Open sores in the lining of the stomach or the first part of the small intestine. Most are caused by Helicobacter pylori infection or anti-inflammatory painkillers.
Condition-specific references are below. Individual claims and this page have not been clinically reviewed. Read about this content.
What happens in the body
H. pylori and NSAIDs weaken the protective mucus and bicarbonate barrier, so acid and pepsin erode the lining.
Causes
- Helicobacter pylori infection
- NSAIDs (ibuprofen, naproxen, aspirin)
- Rarely Zollinger–Ellison syndrome or severe physiological stress
Risk factors
- NSAID or aspirin use, especially with steroids or anticoagulants
- Smoking
- Older age
- H. pylori infection
Symptoms
- Burning or gnawing upper abdominal pain
- Pain related to meals
- Bloating and nausea
- Bleeding: black tarry stools, vomiting blood
- Sometimes no pain until a complication occurs
Diagnosis — tests and examinations
- H. pylori breath, stool antigen or biopsy test
- Endoscopy (gastric ulcers are biopsied to exclude cancer)
- Blood count for anaemia
Treatment
Medicines and medical treatment
- Proton-pump inhibitor for 4–8 weeks
- H. pylori eradication: PPI plus two antibiotics (triple or quadruple therapy) with a test of cure
- Stop NSAIDs or add PPI protection
Operations and procedures
- Endoscopic therapy for bleeding ulcers (clips, heat, adrenaline injection)
- Surgery for perforation or uncontrolled bleeding
Self-care, home remedies and lifestyle
- Avoid NSAIDs; use paracetamol for pain
- Stop smoking
- Limit alcohol
Possible complications
- Bleeding
- Perforation (peritonitis)
- Gastric outlet obstruction
Prevention
- Using PPI protection with long-term NSAIDs
- Treating H. pylori
Outlook
Most ulcers heal in weeks; eradicating H. pylori makes recurrence uncommon.
When to see a doctor
Seek emergency care for vomiting blood, black stools, fainting or sudden severe abdominal pain.
Sources and further reading
These sources cover this condition. They have not been checked against every statement on this page.
Related conditions
Educational overview, not medical advice. Treatment varies by person and location. Consult a qualified health professional for diagnosis or care. Read our content and model notes and privacy information.