Peptic Ulcer Disease
Also known as Stomach ulcer, Duodenal ulcer
This article is general health information for the selected condition. It is not a diagnosis and does not replace clinical judgement. If you have questions or need treatment advice, please consult a qualified healthcare professional.
What is peptic ulcer disease?
Peptic ulcers are breaks in the lining of the stomach or duodenum, caused overwhelmingly by Helicobacter pylori infection or by nonsteroidal anti inflammatory drugs. Stress and spicy food are not causes, though they may aggravate symptoms. Testing for and eradicating H pylori cures most ulcers and prevents recurrence.
Causes
- Helicobacter pylori infection
- Nonsteroidal anti inflammatory drugs including aspirin
- Smoking
- Rarely Zollinger Ellison syndrome
- Severe physiological stress in critical illness
Symptoms
- Burning or gnawing upper abdominal pain
- Pain relieved or worsened by eating depending on ulcer site
- Night time pain waking the person
- Bloating and early fullness
- Nausea
- Vomiting blood or coffee ground material
- Black tarry stools
Risk factors
- H pylori infection
- Regular NSAID or aspirin use
- Smoking
- Excess alcohol
- Older age
- Concurrent steroid or anticoagulant use
Diagnosis
- Urea breath test or stool antigen test for H pylori
- Upper gastrointestinal endoscopy
- Biopsy to exclude malignancy in gastric ulcers
- Full blood count to detect anaemia
- Stopping acid suppression before H pylori testing to avoid false negatives
Treatment
- H pylori eradication with combination antibiotics and a proton pump inhibitor
- Proton pump inhibitor therapy to heal the ulcer
- Stopping or minimising NSAIDs
- Gastroprotection when NSAIDs cannot be avoided
- Smoking cessation and alcohol reduction
- Endoscopic treatment or surgery for bleeding or perforation
- Confirmation of eradication after treatment
Self care
- Complete the full H pylori eradication course exactly as prescribed
- Stop or minimise anti inflammatory painkillers such as ibuprofen
- Use paracetamol for pain relief instead where possible
- Stop smoking, which delays ulcer healing
- Reduce alcohol intake
- Eat smaller regular meals if large meals worsen pain
When to see a doctor
Book an appointment if:
- Pain that persists after completing treatment
- Symptoms returning after previously settling
- Difficulty swallowing or food sticking
- Unintentional weight loss
- Persistent nausea or vomiting
- Needing regular anti inflammatory medicines for another condition
Some symptoms need emergency care rather than an appointment. See the warning signs listed above.
Prevention
- Test for and eradicate H pylori where infection is present
- Use anti inflammatory painkillers sparingly and with food
- Take gastroprotection if long term anti inflammatory use is unavoidable
- Stop smoking
- Limit alcohol
- Confirm H pylori has cleared after treatment
Outlook
Most ulcers heal fully within weeks of acid suppression, and eradicating H pylori prevents recurrence in the large majority. Where anti inflammatory medicines caused the ulcer, stopping them or adding gastroprotection is usually effective. Untreated ulcers can bleed or perforate, which is why symptoms that persist or recur should be reassessed rather than managed indefinitely with acid suppression.
Common questions
Do spicy food and stress cause ulcers?
No. The overwhelming majority are caused by H pylori infection or anti inflammatory medicines. Spicy food and stress may aggravate symptoms but do not create the ulcer.
When is an ulcer an emergency?
Vomiting blood or coffee ground material, black tarry stools, sudden severe abdominal pain, fainting or a rapid pulse suggest bleeding or perforation and require emergency assessment.
Why check that H pylori has been cleared?
Eradication fails in a proportion of people because of antibiotic resistance. Confirming clearance, usually at least four weeks after treatment, prevents ulcer recurrence and reduces stomach cancer risk.
References
Important: Dard AI is not a medical device and does not diagnose, treat, or replace clinician judgement. This article is general information only. Always consult a qualified healthcare professional about diagnosis and treatment, and seek emergency care for severe or rapidly worsening symptoms.