Peptic Ulcer Disease
Ulceration of the stomach or duodenum, usually from H. pylori or NSAID use.
Overview
Peptic ulcer disease (PUD) is a break in the mucosal lining of the stomach (gastric ulcer) or duodenum. Helicobacter pylori infection and non-steroidal anti-inflammatory drugs (NSAIDs) account for most cases. Modern treatment heals ulcers and prevents recurrence.
Symptoms
- • Burning or gnawing epigastric pain (gastric: worse with food; duodenal: relieved by food)
- • Bloating, nausea, early satiety
- • Heartburn and indigestion
- • Black tarry stools (melaena) or vomiting blood — bleeding ulcer
Risk factors
- • H. pylori infection
- • Long-term NSAID or aspirin use
- • Older age (>65)
- • Previous ulcer or GI bleed
- • Concurrent steroids or anticoagulants
Causes
- • Helicobacter pylori infection
- • NSAIDs (including aspirin)
- • Smoking, heavy alcohol
- • Stress in critical illness (stress ulceration)
- • Zollinger-Ellison syndrome (rare gastrin-secreting tumour)
🚨 Red flags — seek urgent care
- • Vomiting blood or coffee-ground vomit — emergency
- • Black tarry stools — emergency
- • Sudden severe abdominal pain — possible perforation, emergency
- • Unintentional weight loss, persistent vomiting, dysphagia, anaemia
When to seek care
- • Persistent dyspepsia for ≥4 weeks
- • Any alarm symptom — urgent endoscopy
- • Need to use regular NSAIDs
Diagnosis
- • H. pylori testing — urea breath test or stool antigen (stop PPI 2 weeks before)
- • Upper GI endoscopy in patients with alarm features or age >55 with new dyspepsia
- • Biopsy to exclude malignancy in gastric ulcers and confirm healing
Treatment
- • H. pylori eradication: 7–14 days triple therapy (PPI + amoxicillin + clarithromycin or metronidazole)
- • Stop NSAIDs where possible; if essential, co-prescribe a PPI
- • PPI (omeprazole, lansoprazole) for 4–8 weeks for ulcer healing
- • Endoscopic haemostasis for bleeding ulcers; surgery for perforation
- • Lifestyle: stop smoking, reduce alcohol
Prevention
- • Avoid unnecessary NSAIDs; use lowest effective dose
- • PPI cover with NSAIDs in high-risk patients
- • H. pylori test-and-treat in dyspepsia
- • Stop smoking
Complications
- • Upper GI bleeding
- • Perforation and peritonitis
- • Gastric outlet obstruction
- • Gastric cancer (long-term H. pylori)
Prognosis
Modern eradication and PPI therapy heal more than 90% of ulcers and dramatically reduce recurrence. Bleeding ulcers carry 5–10% mortality, mainly in older patients with comorbidity.
Education & self-care
Most peptic ulcers heal with H. pylori eradication and PPI therapy. Any black stool, blood vomiting or severe abdominal pain is an emergency.
Frequently asked questions
Is spicy food a cause of ulcers?
No. Spicy food may aggravate symptoms but does not cause ulcers. H. pylori and NSAIDs are the main causes.
Do I need to repeat H. pylori testing?
Yes — confirm eradication 4 weeks after finishing antibiotics, off PPIs, especially after a bleeding ulcer.
Is H. pylori always treated?
Yes when an ulcer or gastric MALT lymphoma is present. A 7-day course of triple therapy (PPI plus two antibiotics) cures most infections; eradication should be confirmed with a urea breath or stool antigen test.
Can NSAIDs cause ulcers?
Yes — they are a leading non-H. pylori cause. People needing long-term NSAIDs at high risk should take a PPI for gastric protection.
When is urgent endoscopy needed?
Coffee-ground vomiting, melaena (black tarry stool), haematemesis, unexplained iron-deficiency anaemia, or new dyspepsia over age 55 with weight loss all warrant urgent endoscopic assessment.