Table of Contents
What is Peptic Ulcer Disease?
Peptic Ulcer Disease (PUD) is a condition where open sores develop on the lining of the stomach (gastric ulcers) or the upper part of the small intestine (duodenal ulcers). This happens when the protective mucous barrier becomes weak, allowing stomach acid to damage the underlying tissue.
The most common causes include Helicobacter pylori infection, long-term use of certain painkillers (NSAIDs), and other factors that upset the balance between acid and the stomach’s natural defenses. PUD can affect anyone, but it’s more common in adults with duodenal ulcers often seen in younger people and gastric ulcers in those over 50.
Without timely treatment, ulcers can lead to serious problems like bleeding or perforation, so early diagnosis matters.
Types of Ulcers: Gastric vs Duodenal
Peptic ulcers mainly occur in two locations, the stomach and the first part of the small intestine (duodenum). While both share similar causes, their symptoms and patterns can differ.
Gastric Ulcer (Stomach)
A gastric ulcer forms on the lining of the stomach, often due to weakened mucosal protection against stomach acid. A key sign is pain that typically appears shortly after eating, as food stimulates acid production. Other symptoms may include bloating, nausea, and reduced appetite. Common triggers are Helicobacter pylori infection, long-term NSAID use, smoking, and excessive alcohol.
Duodenal Ulcer (First Part of Small Intestine)
A duodenal ulcer develops in the first section of the small intestine, just beyond the stomach. The classic symptom is pain several hours after meals or at night, which often improves temporarily after eating or drinking milk. Many patients also experience a burning or gnawing sensation. The main causes are similar to gastric ulcers, with H. pylori being the most common factor.
Symptoms & Red Flags
The most common sign of a peptic ulcer is a burning pain in the upper abdomen (epigastric pain), which may be mild to severe and can come and go. Some people also experience bloating, nausea, or a feeling of fullness even after eating small meals.
Red-flag symptoms that require urgent medical attention include:
Signs of bleeding, such as vomiting blood or material that looks like coffee grounds.
Black or tarry stools, which may indicate digested blood.
Sudden, intense stomach pain, suggesting possible perforation.
Unexplained weight loss or persistent vomiting.
Main Causes & Risk Factors
Peptic ulcers develop when the balance between the stomach’s protective lining and damaging factors such as acid and bacteria is disrupted. Several causes and risk factors can contribute to this imbalance.
Helicobacter pylori (H. pylori)
The bacterium Helicobacter pylori is one of the leading causes of peptic ulcers worldwide. It weakens the stomach and duodenal lining, making them more vulnerable to acid damage. Testing for H. pylori is important because treatment not only heals the ulcer but also reduces the chance of recurrence. The infection spreads mainly through contaminated food, water, or close contact. If left untreated, H. pylori can lead to complications like bleeding or even stomach cancer.
NSAIDs and Painkillers
Frequent or long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, and diclofenac can damage the stomach lining by reducing protective mucus production. This risk is higher in older adults, people with a previous ulcer history, and those taking high doses or multiple NSAIDs. Using the lowest effective dose, taking medicines with food, and adding protective drugs like PPIs (as advised by a doctor) can lower the risk.
Other Contributors
Lifestyle and health factors can also play a role. Smoking slows ulcer healing and increases recurrence risk, while heavy alcohol use irritates and erodes the stomach lining. Severe physical stress from major illness or surgery may trigger ulcers, and certain chronic conditions like liver or kidney disease can increase susceptibility.
How Peptic Ulcers Are Diagnosed
Diagnosing a peptic ulcer involves confirming its presence, identifying the cause, and checking for possible complications. Doctors often start with noninvasive tests to detect H. pylori infection, the most common cause of ulcers.
Urea breath test – You drink a special solution, and your breath is analyzed for gases that indicate H. pylori activity.
Stool antigen test – Detects H. pylori proteins in a stool sample, useful both for diagnosis and to confirm successful treatment.
If symptoms are severe, persistent, or include red flags like bleeding, an upper endoscopy is recommended. This procedure uses a thin, flexible tube with a camera to directly view the stomach and duodenum. During endoscopy, the doctor can also take a biopsy, a small tissue sample to check for H. pylori and rule out other conditions, including cancer.
⚠ Disclaimer
The content provided in this blog is for educational and informational purposes only. It should not be taken as medical advice. Always consult a licensed healthcare professional before starting, changing, or stopping any medication. Treatment decisions should be based on a doctor’s evaluation of your individual health status and medical history.
Evidence-Based Treatment Options
Treatment for peptic ulcer disease focuses on healing the ulcer, removing its cause, and preventing recurrence. The approach depends on whether the ulcer is related to H. pylori infection, NSAID use, or other factors.
H. pylori Eradication Therapy
If H. pylori is present, eradication therapy is the standard of care. The most common first-line option is bismuth quadruple therapy for 14 days, which includes a proton pump inhibitor (PPI), bismuth, and two antibiotics. In some cases, a PPI-based triple therapy is used, but growing antibiotic resistance makes quadruple therapy preferable in many regions.
Adherence is crucial, incomplete treatment increases the risk of failure and resistance. After completing the course, a confirm eradication test (usually a urea breath test or stool antigen test) is recommended to ensure the bacteria is gone.
Treating Non-H. pylori or NSAID-Related Ulcers
If the ulcer is not caused by H. pylori, the focus shifts to removing the irritant and promoting healing. For NSAID-related ulcers, stopping or reducing the NSAID is key. If painkillers are still needed, switching to a safer alternative under medical advice is recommended.
A PPI course (often 4–8 weeks) is prescribed to reduce acid and allow the lining to heal. Gastroprotective strategies such as adding misoprostol or using COX-2 selective NSAIDs may be considered for patients who must continue painkillers. In rare cases of refractory ulcers that don’t heal despite treatment, further testing is done to identify hidden causes.
Diet for Ulcer Relief: What to Eat & What to Limit
A peptic ulcer diet plan focuses on foods that support healing and reduce irritation. Include gentle, soothing items like probiotic yogurt or curd, ripe bananas, well-cooked vegetables, lean proteins such as chicken or fish, and whole grains. These ulcer-friendly meals help calm the stomach and promote recovery.
At the same time, limit triggers like alcohol, very spicy dishes, deep-fried snacks, and highly acidic foods such as citrus or tomato-based sauces. Avoiding these foods to avoid with ulcer can speed up healing and prevent discomfort. Adding more probiotic foods for ulcers may also improve gut health and reduce inflammation.
Lifestyle Tips to Prevent Flares & Recurrence
Adopting a few healthy habits can go a long way in preventing ulcer flare-ups and reducing the risk of recurrence. Eat smaller, balanced meals throughout the day instead of heavy portions, and avoid late-night eating to give your stomach time to rest. Quit smoking, as it delays healing and worsens ulcers. If you drink alcohol, do so in moderation or avoid it completely. For pain relief, steer clear of NSAIDs unless your doctor advises otherwise, and always discuss safer options with a healthcare professional.
Common Myths vs Facts
Many misconceptions surround peptic ulcers. Contrary to popular belief, spicy food doesn’t directly cause ulcers, though it may worsen symptoms in some people. Drinking milk may provide temporary relief, but it can also trigger more acid production, slowing healing. Stress alone isn’t a direct cause of ulcers, most cases are linked to H. pylori infection or long-term NSAID use. Understanding these facts helps in better ulcer management and avoiding unnecessary restrictions.
FAQ
How do doctors confirm an ulcer without endoscopy?
Doctors may use noninvasive ulcer test options like stool antigen tests, urea breath tests for H. pylori, and blood tests to check infection markers, avoiding the need for an endoscopy in mild cases.
Which is better for ulcer pain PPI or H2 blocker?
For most cases, PPI vs H2 blocker for ulcers, PPIs usually provide stronger and longer-lasting acid suppression, while H2 blockers may work for milder symptoms or short-term relief.
Can ulcers come back after H. pylori cure?
While ulcer recurrence after eradication is rare, it can happen if reinfection occurs, long-term NSAID use continues, or other risk factors remain untreated.
What should I eat during an ulcer flare-up?
The best foods during ulcer flare are soft, low-acid, non-spicy options like bananas, oatmeal, yogurt, and steamed vegetables, which are gentle on the stomach.
Is it safe to take painkillers if I had an ulcer?
For safe painkiller choice post ulcer, avoid NSAIDs like ibuprofen; instead, use acetaminophen (paracetamol) under medical guidance to reduce the risk of ulcer irritation.
Conclusion
Ulcers can be effectively managed with timely diagnosis, the right treatment approach, and supportive dietary and lifestyle habits. Whether caused by H. pylori, certain medications, or other factors, understanding your options from noninvasive tests to appropriate medicines can make a big difference. By following medical advice, making healthy food choices, and avoiding triggers, you can reduce discomfort, prevent recurrence, and protect your long-term digestive health.