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DigestiveICD-10: K27About 4.6 million cases per year in the United States

Peptic Ulcer Disease

Also known as: Stomach Ulcer, Gastric Ulcer, Duodenal Ulcer

Peptic ulcer disease involves open sores that develop on the inner lining of the stomach (gastric ulcers) or the upper portion of the small intestine (duodenal ulcers). The most common causes are Helicobacter pylori infection and chronic use of nonsteroidal anti-inflammatory drugs (NSAIDs). Peptic ulcers can cause burning abdominal pain and, if untreated, may lead to serious complications such as bleeding, perforation, or obstruction.

Symptoms

Burning or gnawing abdominal pain, often between meals or at night
Pain that improves with eating or antacids (duodenal ulcers)
Pain that worsens with eating (gastric ulcers)
Bloating and feeling of fullness
Nausea
Heartburn
Dark or tarry stools (melena) indicating bleeding
Vomiting blood (hematemesis)

Causes

  • Helicobacter pylori bacterial infection
  • Chronic use of NSAIDs (aspirin, ibuprofen, naproxen)
  • Zollinger-Ellison syndrome (rare, gastrin-secreting tumor)
  • Excessive stomach acid production

Risk Factors

  • H. pylori infection
  • Regular NSAID or aspirin use
  • Smoking
  • Excessive alcohol consumption
  • Older age
  • History of peptic ulcer disease

Diagnosis

  • Upper endoscopy (esophagogastroduodenoscopy/EGD) with biopsy
  • H. pylori testing (urea breath test, stool antigen test, or biopsy-based tests)
  • Complete blood count to check for anemia from bleeding
  • Fasting gastrin level if Zollinger-Ellison syndrome is suspected

Treatment

  • Proton pump inhibitors (omeprazole, pantoprazole, esomeprazole)
  • H. pylori eradication with triple or quadruple antibiotic therapy
  • Discontinuation of offending NSAIDs
  • H2 receptor blockers (famotidine) as adjunctive therapy
  • Endoscopic treatment for actively bleeding ulcers
  • Surgery for complications (perforation, obstruction, uncontrolled bleeding)

Prevention

  • Test and treat H. pylori infection
  • Use the lowest effective dose of NSAIDs for the shortest duration
  • Take a PPI for gastroprotection if chronic NSAIDs are necessary
  • Quit smoking
  • Limit alcohol consumption

When to See a Doctor

  • Persistent burning abdominal pain, especially between meals or at night
  • Black, tarry stools or vomiting blood
  • Sudden, severe abdominal pain (possible perforation — emergency)
  • Unintentional weight loss with abdominal symptoms

Frequently Asked Questions

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Medical Disclaimer: This content is for educational and informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider.

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