What Is a Peptic Ulcer? Symptoms, Causes, Diagnosis and Treatment

Created: 24.06.2024 · Last Updated: 17.08.2026 · Category: Gastroenterology · Prepared by the Academic Hospital Web and Editorial Board.

What Is a Peptic Ulcer?

A peptic ulcer is an open sore in the lining of the stomach or the first part of the small intestine, called the duodenum.

An ulcer in the stomach is called a gastric ulcer, while an ulcer in the duodenum is called a duodenal ulcer.

Peptic ulcers develop when the protective mechanisms of the stomach or duodenal lining are impaired and the tissue becomes vulnerable to acid, digestive enzymes or other damaging factors.

What Are the Symptoms of a Peptic Ulcer?

Some peptic ulcers cause no symptoms. When symptoms occur, upper abdominal pain or discomfort is common.

  • Burning or aching pain in the upper abdomen
  • Pain when the stomach is empty or at night
  • Pain that may improve or worsen after eating
  • Early satiety
  • Uncomfortable fullness after meals
  • Nausea
  • Bloating or belching

Unexplained weight loss, persistent vomiting, anaemia, black stools or vomiting blood require further assessment for complications or other significant gastrointestinal disease.

What Causes Peptic Ulcers?

The two most important causes of peptic ulcer disease are:

  • Helicobacter pylori infection
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)

Less common causes include selected severe systemic illnesses, conditions affecting gastric blood flow, Crohn's disease, uncommon infections and Zollinger-Ellison syndrome.

How Is H. pylori Related to Peptic Ulcers?

Helicobacter pylori is a bacterium that can colonise the stomach lining and cause chronic inflammation.

It is an important cause of both gastric and duodenal ulcers.

When H. pylori is identified in a patient with peptic ulcer disease, eradication therapy can help the ulcer heal and substantially reduce the risk of recurrence.

Can Painkillers Cause Peptic Ulcers?

Yes. Medicines such as aspirin, ibuprofen, naproxen and other NSAIDs can reduce protective mechanisms in the stomach and duodenum and increase the risk of ulceration and gastrointestinal bleeding.

Risk can be higher with older age, previous ulcers or gastrointestinal bleeding, higher doses, prolonged treatment, multiple NSAIDs, H. pylori infection or selected concomitant medicines.

Patients taking aspirin, antiplatelet or anticoagulant therapy for cardiovascular reasons should not stop treatment without medical advice.

Do Stress, Spicy Food or Coffee Cause Ulcers?

Everyday psychological stress, fasting, spicy food and coffee are not considered the main causes of peptic ulcer disease.

There is also no special ulcer diet that has been proven to heal or prevent peptic ulcers in all patients.

If particular foods or drinks clearly aggravate an individual's pain or dyspeptic symptoms, they can be reduced according to personal tolerance.

Smoking can adversely affect ulcer healing and should be stopped.

The priority is not a universal list of prohibited foods. The underlying cause of the ulcer should be identified and treated.

What Are the Complications of Peptic Ulcers?

Complications can include gastrointestinal bleeding, perforation, penetration into adjacent organs and obstruction of the gastric outlet.

Bleeding may present with vomiting blood, coffee-ground vomit, black tarry stools, dizziness, fainting or iron-deficiency anaemia.

Perforation can cause sudden, severe and persistent abdominal pain and requires urgent medical assessment.

How Is a Peptic Ulcer Diagnosed?

Assessment considers symptoms, age, medication use, previous ulcer history and the presence of alarm features.

Tests can include:

  • Upper gastrointestinal endoscopy
  • Urea breath testing for H. pylori
  • Stool antigen testing for H. pylori
  • Biopsy-based H. pylori testing during endoscopy
  • Blood tests when anaemia or bleeding is suspected

Does Every Suspected Peptic Ulcer Require Endoscopy?

No. The need for endoscopy depends on the patient's age, symptoms and clinical risk.

Endoscopy is particularly important when there is gastrointestinal bleeding, unexplained weight loss, persistent vomiting, iron-deficiency anaemia, difficulty swallowing, concern about gastric malignancy or persistent symptoms despite treatment.

Endoscopy allows direct visualisation of an ulcer and biopsy when required.

How Are Peptic Ulcers Treated?

Treatment aims both to heal the ulcer and address its underlying cause.

Management can include:

  • Proton pump inhibitors
  • H. pylori eradication when infection is present
  • Reviewing NSAID treatment
  • Smoking cessation
  • Endoscopic, radiological or surgical treatment when complications occur

How Is H. pylori Treated?

Patients with H. pylori-associated peptic ulcer disease require eradication therapy.

Treatment generally combines potent acid suppression with multiple antimicrobial agents.

Because antibiotic resistance is increasingly important, treatment should be selected according to previous antibiotic exposure, local resistance patterns, allergies and previous eradication regimens.

Is a Test of Cure Needed After H. pylori Treatment?

Yes. Current recommendations support confirming successful eradication after treatment.

A urea breath test, stool antigen test or selected biopsy-based testing can be used.

Testing is generally performed at least 4 weeks after antibiotics have been completed.

To reduce false-negative results, PPIs or PCABs are generally withheld for at least 2 weeks before testing, under medical guidance.

Improvement in symptoms does not prove that H. pylori has been eradicated.

How Are NSAID-Related Ulcers Managed?

If an ulcer is related to NSAID therapy, the indication for that medicine should be reviewed.

Depending on clinical circumstances, treatment may involve stopping the NSAID, reducing its dose, changing pain treatment or providing gastroprotection with a proton pump inhibitor when continued NSAID therapy is necessary.

Cardiovascular aspirin or antiplatelet treatment should not be altered without appropriate medical assessment.

Does a Gastric Ulcer Need Follow-up Endoscopy?

Biopsy may be required when a gastric ulcer is identified because some gastric cancers can have an ulcer-like appearance.

Follow-up endoscopy may be considered when the initial biopsy was inadequate, the ulcer appears suspicious, symptoms persist or confirmation of healing is clinically important.

The need for follow-up is individualised rather than identical for every patient.

How Is Peptic Ulcer Bleeding Managed?

Patients with haematemesis, coffee-ground vomiting, melaena or circulatory symptoms should be assessed as having potential acute upper gastrointestinal bleeding.

Initial management includes assessment and stabilisation of circulation when necessary.

After adequate haemodynamic resuscitation, upper gastrointestinal endoscopy is generally recommended within 24 hours.

Current ESGE guidance does not recommend routine endoscopy within 6 or 12 hours unless haemodynamic instability persists despite adequate resuscitation.

Active bleeding or other high-risk ulcer features can be treated using endoscopic clips, thermal therapy, injection techniques or other haemostatic methods.

Adequate resuscitation comes first. Performing endoscopy as early as technically possible is not automatically better for every patient.

What Are the Signs of Ulcer Perforation?

Perforation typically causes sudden and severe abdominal pain that does not settle.

The abdomen may become rigid and pain can rapidly become generalised.

Because perforation can cause peritonitis, urgent assessment and treatment are required.

When Should Emergency Care Be Sought?

Seek urgent medical assessment for:

  • Vomiting red blood
  • Coffee-ground vomit
  • Black, tarry stools
  • Fainting or marked dizziness
  • Palpitations, cold sweating or low blood pressure
  • Sudden severe abdominal pain
  • A rigid abdomen
  • Rapid deterioration in general condition

Have Persistent Upper Abdominal Symptoms Assessed

Persistent upper abdominal pain, nocturnal pain, early satiety, anaemia or suspected ulcer disease may require assessment for H. pylori and other gastrointestinal conditions.

Frequently Asked Questions

What is a peptic ulcer?
A peptic ulcer is an open sore in the lining of the stomach or duodenum. Ulcers in the stomach are called gastric ulcers, while ulcers in the duodenum are called duodenal ulcers.
What are the most common causes of peptic ulcers?
The two most important causes of peptic ulcer disease are Helicobacter pylori infection and the use of nonsteroidal anti-inflammatory drugs such as aspirin, ibuprofen or naproxen.
Do stress and spicy food cause peptic ulcers?
Everyday stress and spicy foods are not considered primary causes of peptic ulcers. Certain foods may worsen symptoms in some people, but treatment should focus on H. pylori, NSAID exposure and other true causes of ulcer disease.
Does every suspected ulcer require endoscopy?
No. The need for endoscopy depends on age, symptoms and clinical risk. Endoscopy is particularly important in gastrointestinal bleeding, unexplained weight loss, persistent vomiting, iron-deficiency anaemia or other alarm features.
Should H. pylori be retested after treatment?
Yes. Successful H. pylori eradication should be confirmed with an appropriate test. Testing is generally performed at least 4 weeks after antibiotics have been completed and after PPIs or PCABs have been withheld for at least 2 weeks.
Can a peptic ulcer heal completely?
Most peptic ulcers can heal with appropriate acid suppression and treatment of the underlying cause. Eradicating H. pylori and reviewing NSAID use are particularly important for reducing recurrence.
What are the signs of a bleeding ulcer?
Vomiting red blood, coffee-ground vomit, black tarry stools, dizziness, fainting or anaemia can indicate ulcer bleeding. Active bleeding requires urgent medical assessment.
When is endoscopy performed for ulcer bleeding?
In acute upper gastrointestinal bleeding, circulation is assessed and stabilised first. In most patients, upper endoscopy is recommended within 24 hours after adequate resuscitation.
Academic Hospital note: Peptic ulcer management involves more than suppressing stomach acid. The cause should be investigated, especially H. pylori infection and NSAID use. When H. pylori is treated, successful eradication should be confirmed. Vomiting blood, black stools or sudden severe abdominal pain requires urgent assessment rather than a routine appointment. You can book an appointment.

References

  1. Academic Hospital. Peptic Ulcer
  2. National Institute of Diabetes and Digestive and Kidney Diseases. Peptic Ulcers
  3. American College of Gastroenterology. ACG Clinical Guideline on the Treatment of Helicobacter pylori Infection
  4. European Society of Gastrointestinal Endoscopy. Endoscopic Diagnosis and Management of Peptic Ulcer Bleeding: ESGE Guideline – Update 2026