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Peptic ulcers

Peptic ulcers are sores that can develop in your gastrointestinal tract (GI tract). The GI tract consists of your oesophagus, stomach and intestines and is where you break down and absorb food. When the protective lining of this tract (the mucosa) is damaged, peptic ulcers occur. This damage can happen for many reasons, but usually it’s because you:

  • have been infected by the bacteria Helicobacter pylori (H. pylori)
  • are regularly using a type of painkiller called NSAIDs (non-steroidal anti-inflammatory drugs)

Usually, the lining of your GI tract protects it from damage by chemicals and stomach acid that help to digest the food you eat. If the amount of gastric acid increases or the mucosa is weakened, the acid can damage your GI tract. This can then cause a peptic ulcer.

Both men and women of all ages can get peptic ulcers. However, they are more common in people over the age of 65.

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How a peptic ulcer develops
Peptic ulcers are ulcers of the stomach and small bowel


  • Types Types of peptic ulcers

    Peptic ulcers can occur in various parts of your GI tract. So they may be:

    • oesophageal (along the tube that carries food from your mouth into your stomach)
    • gastric (in your stomach)
    • duodenal (in the first part of your small intestine, where food goes once it leaves your stomach)
    Image showing the digestive system
  • Symptoms Symptoms of peptic ulcers

    If you have a peptic ulcer, it may not cause you any symptoms to start with. Instead symptoms may occur quite suddenly later on. This often happens if you’re older or taking NSAIDs (non-steroidal anti-inflammatory drugs).

    If you do have symptoms, the most common one is abdominal (tummy) pain. If your ulcer is in your duodenum (duodenal ulcer), this pain tends to come on a couple of hours after having a meal. Generally, it goes away when you eat again. You may also feel pain at night and when you have an empty stomach. If you have an ulcer in your stomach (gastric ulcer), you’ll probably find that the pain comes on when you eat. If your ulcer is in your oesophagus (oesophageal ulcer), it can cause you to have abdominal or lower chest pain. You may also have trouble swallowing.

    Indigestion (dyspepsia) for more than a month might also mean you have a peptic ulcer. If you have indigestion, you may:

    • feel sick (nauseous)
    • vomit
    • feel bloated
    • burp
    • have heartburn (gastro-oesophageal reflux) – when the contents of your stomach go back up your oesophagus

    If you have any of the following symptoms, it’s particularly important that you contact your GP for advice. These symptoms could mean that you have something other than a peptic ulcer. They include:

    • losing weight without dieting
    • seeing blood in your vomit or bowel movements
    • having trouble swallowing
    • feeling full soon after you’ve started eating a meal
  • Diagnosis Diagnosis of peptic ulcers

    Your GP will aim to find out:

    • whether or not you have a peptic ulcer and if so, what type (gastric, oesophageal or duodenal)
    • the cause of your ulcer – this will help your GP to treat you effectively

    Your GP will ask you about your symptoms and medical history. They may also feel your abdomen (palpation) to see if you have any tenderness or pain.

    H. Pylori (Helicobacter Pylori) infection and long-term use of NSAIDs (non-steroidal anti-inflammatory drugs) are the main causes of peptic ulcers. So your GP will want to find out if either of these could be causing your symptoms. If so, it could mean that you have a peptic ulcer. They will probably ask, but if not, make sure you tell your GP if you’ve been taking over-the-counter NSAIDs (such as aspirin and ibuprofen) regularly for anything. If your GP thinks a H. pylori infection might be the cause, they will need to do some tests to check this.

    H. pylori tests

    There are a few different ways you could be tested to see whether or not you have a H. pylori infection.

    • Blood test. Your doctor will take a small sample of blood which is tested for antibodies against the H. pylori bacteria. Antibodies are produced by your immune system when it detects something that may be harmful. So, if you have these antibodies, it shows you are or have been infected with H. pylori.
    • Faecal sample. For this test, you will need to give your doctor a small sample of your faeces. It will be tested for H. pylori.
    • Breath test. If you’re asked to have a breath test, it will be done at the hospital. During this test, you’ll be asked to swallow a liquid containing a harmless radioactive chemical. If you’re infected with H. pylori, this chemical will be broken down by the bacteria and the gas carbon dioxide produced. After drinking the liquid you’ll be asked to breathe into a machine which measures the levels of radioactivity in the carbon dioxide. If this shows a high level, it probably means you’re currently infected with H. pylori.


    If you’re over 55 or have any worrying symptoms, such as difficulty swallowing, you’ll initially be referred for a gastrointestinal endoscopy (also called a gastroscopy).

    If your GP arranges for you to have a gastroscopy, you’ll need to go to hospital or a day unit in a treatment centre for the procedure. It’s done using a narrow, flexible, tube-like camera called an endoscope. You’ll be asked to swallow the endoscope which your endoscopist then passes through your oesophagus, stomach and duodenum. They’ll examine these areas to see if there is an ulcer or anything else wrong.

    If you have an ulcer, a biopsy (a small sample of tissue) is taken. This sample can be tested to see if your ulcer is caused by H. pylori. Rarely, the ulcerated area may be cancerous, so endoscopy provides a good opportunity to check that it isn’t.

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  • Treatment Treatment of peptic ulcers

    It’s really important that you get treatment if you’re diagnosed with a peptic ulcer. If treated properly, duodenal ulcers will heal in around four weeks and gastric ulcers in eight. And if your ulcer is caused by H. pylori (Helicobacter pylori), once you’ve got rid of the bacteria, the chance of your ulcer coming back is reduced.


    Peptic ulcers can be caused or made worse by certain lifestyle factors such as:

    • smoking
    • drinking excessive amounts of alcohol

    So if you smoke, trying to quit may help reduce your symptoms, as may cutting down on how much alcohol you drink. What you eat and drink may also affect how you feel. Although there is no special diet plan that you should follow, healthy eating is very important. It’s also advisable that you avoid food or drinks that aggravate your symptoms. For some people, these have included:

    • spicy and fatty foods
    • fizzy drinks
    • caffeinated drinks, such as tea and coffee

    Other people have found that eating bland or milky foods has helped with their symptoms.


    H. pylori related ulcers

    If your peptic ulcer is caused by a H. pylori infection, you’ll be prescribed a course of antibiotics to clear the infection. You’ll probably need to take the antibiotics for between one and two weeks.

    You’ll also be given medicines which help to prevent further damage to your GI tract and allow your ulcer the chance to heal. These groups of medicines work by decreasing how much stomach acid you produce.

    • PPIs (proton-pump inhibitors). You may be asked to take a PPI, such as omeprazole or lansoprazole, for around six to eight weeks.
    • H2-receptor antagonists. If treatment with a PPI doesn’t work particularly well for you, your doctor may prescribe you a H2-receptor antagonist such as ranitidine or famotidine.

    NSAID (non-steroidal anti-inflammatory drug) related ulcers

    If your ulcer is caused by using NSAIDs, you’re likely to be advised to stop taking them so that your ulcer can heal. You’ll also be given a PPI or H2-receptor antagonist to decrease acid production. Overall, these medicines are safe to use but may cause you some temporary side-effects such as diarrhoea or nausea (feeling sick).

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  • Causes Causes of peptic ulcers

    Helicobacter pylori

    The most common cause of peptic ulcers is a stomach infection caused by the bacteria Helicobacter pylori (H. pylori). Lots of people in the UK are infected with H. pylori, but generally the infection doesn’t cause any problems. You may get the bacteria from other people and, if you’re infected, it’s likely that this happened when you where a child. Today, not as many children are getting the infection or passing it on. So you don’t need to worry about taking extra measures to make sure you don’t pass it on, or get infected yourself.

    H. pylori infection is the cause in around nine out of 10 people with duodenal ulcers and eight out of 10 people with gastric ulcers. They happen because the infection can damage the lining of your GI tract. It does this by:

    • causing inflammation
    • interfering with acid production – sometimes H. pylori can disrupt the mechanism that switches off acid production, so your stomach then produces too much acid

    Non-steroidal anti-inflammatory drugs (NSAIDs)

    The second most common cause of peptic ulcers is taking NSAIDs frequently or over a long period of time. Around two out of 10 gastric ulcers and one out of 10 duodenal ulcers are caused by this. You may be familiar with some NSAIDs such as aspirin, ibuprofen or diclofenac. Most people can take these safely, but they can cause problems if you take them regularly. This might be to treat a long-term condition such as rheumatoid arthritis or gout.

    Although NSAIDs are useful for treating pain, a disadvantage is that they can also cause the lining of your GI tract to become weak. This means that damage and peptic ulcers are more likely to happen.

    Other factors that may increase your risk of getting a peptic ulcer include:

    • smoking
    • other people in your family having peptic ulcers
    • getting older
  • Complications Complications of peptic ulcers

    If you get treatment for your peptic ulcer, the outcome is usually very good and complications aren’t very common. However, if you haven’t had treatment or your ulcer has gone unnoticed for a while, complications may develop. They include:

    • bleeding
    • perforation
    • obstruction

    The most common of these is bleeding. It happens if your ulcer wears down (erodes) into any underlying arteries or veins (blood vessels). If your ulcer is bleeding, you’re likely to notice that:

    • you have blood in your vomit
    • your faeces is black and sticky

    It’s possible that your ulcer could erode through the lining of your stomach or duodenum leading to either perforation or penetration. Perforation is when the ulcer erodes through the wall of your stomach or duodenum, causing inflammation of your abdominal lining (peritonitis). Penetration is when your ulcer completely erodes all the way through your stomach or duodenal wall and into other organs. If this happens, you’ll have severe stomach pain.

    The least common complication is obstruction of food passing from your stomach into your duodenum during digestion (this is known as pyloric stenosis). It happens if tissue surrounding your ulcer becomes hard and thick (scars) as your body repeatedly tries to repair damage caused by it. Obstruction may cause you to:

    • feel sick
    • vomit after having a meal
    • lose weight

    If you get any of these complications, it’s likely that you’ll need emergency surgery. So if you have any of the symptoms described, make sure you get urgent medical help.

    Link with cancer

    It’s important to understand the relationship between peptic ulcers and gastric cancer. Peptic ulcers don’t turn into or cause cancer. Instead, if your peptic ulcer is caused by H. pylori infection, it’s the infection that increases your risk of getting stomach cancer later on in life. We know this because people whose ulcers are caused by something other than a H. pylori infection, aren’t at a greater risk of getting gastric cancer.

  • Am I at an increased risk because I take NSAIDs for another condition? Am I at an increased risk of a peptic ulcer because I take NSAIDs for another condition?


    Yes, it’s possible. But if you’re at an increased risk of stomach problems, your doctor probably won’t prescribe you NSAIDs. If they do, it will be at the lowest dose and for the shortest time possible. They’ll also most likely prescribe you a PPI (proton-pump inhibitor) to take with them.

    More information

    NSAIDs are very useful medicines; they work over long periods of time to:

    • reduce inflammation
    • relieve pain
    • help bring down a fever if you have one

    Because of this, they’re really useful for treating conditions where pain (caused by inflammation) happens constantly or very regularly. Some of these conditions include chronic gout and rheumatoid arthritis.

    Overall, NSAIDs are safe to use but if you find yourself taking them regularly, over a long period of time (perhaps for one of the above conditions) you may become affected by them. In particular, the lining of your GI tract (where your food is broken down and absorbed) can weaken, making you more likely to get a peptic ulcer.

    However, if you’re taking NSAIDs like this, it’s probably because you need to and so your doctor is likely to give you a PPI to protect you. Overall, damage to your GI tract lining is limited as the PPI will prevent your stomach from producing too much acid.

    If you’re unsure about your current medication and how it’s working to help you, talk to your pharmacist about this.

  • Resources Resources

    Further information


    • Peptic ulcer disease. BMJ Best Practice., published 14 August 2014
    • Dyspepsia – proven peptic ulcer. NICE Clinical Knowledge Summaries., published February 2015
    • Wallace L. Prostaglandins, NSAIDs and gastric mucosal protection: Why doesn't the stomach digest itself? Phys Rev 2008; 88(4):1547–65. doi:10.1152/physrev.00004.2008
    • Feinstein L, Holman R, Yorita Christensen K, et al. Trends in hospitalisations for peptic ulcer disease, United States, 1998–2005. Emerg Infect Dis 2010; 16(9). doi: 10.3201/eid1609.091126
    • Mea A, Weinberg SL, Segelnick JS, et al. The dentist's quick guide to medical conditions. 1st ed. Oxford: John Wiley & Sons, Inc; 2015
    • Peate I. Anatomy and physiology for nurses at a glance. 1st ed. Oxford: John Wiley & Sons, Inc; 2015
    • Peate I. Pathophysiology for nurses at a glance. 1st ed. Oxford: John Wiley & Sons, Inc; 2015
    • Brooks A, Boyd S, Sanoski C, et al. NAPLEX 2015 strategies, practice and review with two practice tests. 1st ed. Wokingham: Kaplan Publishing Ltd; 2015
    • Gastroenterology. Oxford handbook of geriatric medicine. 2nd ed.(online). Oxford Medicine Online., published July 2012
    • Satish S, Rao C. Diagnosis and management of esophageal chest pain. Gastroenterol Hepatol 2011; 7(1): 50–52
    • Dyspepsia and gastro-oesophageal reflux disease: Investigation and management of dyspepsia, symptoms suggestive of gastro-oesophageal reflux disease, or both. National Institute for Health and Care Excellence (NICE), September 2014.
    • Dyspepsia. The Merck Manuals., Published November 2013
    • Peptic ulcer disease. PatientPlus., published 3 February 2015
    • Stedman's medical dictionary. Lippincott Williams & Wilkins., accessed July 2015
    • Dyspepsia – unidentified cause. NICE Clinical Knowledge Summaries., published February 2015
    • Map of Medicine. Dyspepsia. International View. London: Map of Medicine; 2015 (Issue 2)
    • Ferwana M, Abdulmajeed I, Alhajiahmed A, et al. Accuracy of urea breath test in Helicobacter pylori infection: meta-analysis. World J Gastroenterol 2015; 21(4):1305–14. doi: 10.3748/wjg.v21.i4.1305
    • Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press., accessed July 2015
    • Gastroenterology. Oxford Handbook of Clinical Medicine. 9th ed. (online). Oxford Medicine Online., published January 2014
    • SICS Editore. Gastroscopy. 1st ed. Milan: SICS Editore; 2014
    • Esophagogastroduodenoscopy. Medscape., published 24 June 2015
    • Helicobacter pylori infection. Medscape., published 11 September 2014
    • Peptic ulcer disease. Medscape., published 9 January 2015
    • Peptic ulcers. CORE., published 2 July 2013
    • Nutrition in gastrointestinal diseases. Oxford handbook of nutrition and dietetics. 2nd ed. (online). Oxford Medicine Online., published January 2012
    • Helicobacter pylori. CORE., published 27 February 2015
    • Map of Medicine. Crystal arthropathy. International View. London: Map of Medicine; 2011 (Issue 4)
    • Map of Medicine. Rheumatoid arthritis. International View. London: Map of Medicine; 2012 (Issue 4)
    • Lavelle–Jones M, Dent JA. Master Medicine: Surgery. 3rd ed. Philadelphia: Elsevier Limited; 2008
    • Surgery. Oxford handbook of clinical medicine. 9th ed. (online). Oxford Medicine Online., published January 2014
    • Peptic ulcer disease. The Merck Manuals., published May 2014
    • Mucosa-associated lymphoid tissue workup. Medscape., published 9 December 2014
    • NSAIDs – prescribing issues. NICE Clinical Knowledge Summaries., published July 2015
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