Peptic Ulcers: Types, Symptoms and Treatment


Published: 16 November 2022

What is a Peptic Ulcer?

Peptic ulcers occur in the lining of the stomach or on the upper section of the small intestine (duodenum). They can be categorised as either:

  • Gastric ulcers: Ulcers that occur on the inside of the stomach
  • Duodenal ulcers: Ulcers that occur on the inside of the small intestine.

(Mayo Clinic 2022; American College of Gastroenterology 2021)

Normally, the lining of the stomach and intestines has defences against acid produced by the stomach. However, when something interferes with those defences, the acid may cause damage. A peptic ulcer is a product of this damage; it is an open and inflamed sore (MSD Manual 2021; Mayo Clinic 2022).

While peptic ulcers are common and treatable, it’s crucial that they are diagnosed early in order to avoid severe complications (MSD Manual 2022; Mayo Clinic 2022).

Ulcers vary in size, ranging from millimetres to centimetres. Peptic ulcers can be differentiated from erosions by the depth of penetration. Erosions are typically more superficial (Vakil 2022).

If left untreated, serious complications may occur.

peptic ulcer person with abdominal pain
A peptic ulcer occurs in the lining of the stomach or on the upper section of the small intestine.

Causes of Peptic Ulcers

The most common causes of peptic ulcers are:

  • Helicobacter pylori (H. pylori) bacterial infection
  • Prolonged use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and aspirin.

(Healthdirect 2021; Mayo Clinic 2022)

Note that spicy foods and stress do not cause peptic ulcers, but can worsen symptoms (Mayo Clinic 2022).

Symptoms of Peptic Ulcer

Often - in up to three-quarters of people - peptic ulcers will not present with any symptoms (Mayo Clinic 2022).

If symptoms do occur, they most commonly include a burning or gnawing pain in the upper abdomen. This pain can travel to the chest, neck, belly button or back (Healthdirect 2021). The pain often comes and goes in intervals (Vakil 2022).

Other, less-common symptoms include:

  • Indigestion (heartburn)
  • Loss of appetite
  • Vomiting
  • Feeling full and bloated, or belching
  • Not being able to tolerate fatty foods
  • Nausea.

(Healthdirect 2021)

Eating food may dull the symptoms of duodenal ulcers but will often worsen the symptoms of gastric ulcers (Vakil 2022).

peptic ulcer diagram
Diagram of a peptic ulcer.

What are the Complications of Peptic Ulcers?

Peptic ulcers may lead to the following:

  • Gastrointestinal haemorrhage
    • Passing bloody stools or black, tarry stools
    • Vomiting blood, or blood that looks like ground coffee
  • Perforation through the wall of the stomach or small intestine, which can cause severe infection and pain
  • Stomach cancer risk increases three- to six-fold in patients with H. pylori-related ulcers.

(MSD Manual 2022; Vakil 2022)

Risk Factors for Peptic Ulcers

Peptic ulcers are common and can affect people of any age. However, they mostly occur in people over 60 and men are more commonly affected than women (NHS 2022).

Previously, stress, diet and smoking were thought to be the leading causes of stomach ulcers. It is now known that H. pylori bacteria are the main cause of ulcers (Queensland Government 2017).

H. pylori infection is present in 50 to 70% of patients with duodenal ulcers and 30 to 50% with gastric ulcers (Vakil 2022).

NSAIDs account for more than 50% of peptic ulcers (Vakil 2022).

Smoking is still considered a risk factor for the development of ulcers and the complications they cause. Additionally, smoking is known to impede healing and increase the chance of recurrence. For children with duodenal ulcers, in 50 to 60% of cases, there is a family history - this is thought to be due to H. pylori being transmitted between family members (Vakil 2022).

Treatment of Peptic Ulcers

Treatment of gastric and duodenal ulcers involves removing the cause, which may require:

  • Antibiotics in the case of H. pylori infection
  • Acid-suppressing medications (e.g. proton pump inhibitors)
  • Antacids.

(MSD Manual 2022)

How are Peptic Ulcers Diagnosed?

A general practitioner may suggest an examination if a person has stomach pain characteristic of ulcers.

Tests are needed to confirm the diagnosis:

  • If symptoms do not resolve following multiple weeks of treatment
  • When symptoms first appear in someone over 45
  • If a person is presenting with other symptoms such as weight loss.

(Vakil 2022)

An upper endoscopy is the method most commonly used to diagnose a peptic ulcer, during which, a biopsy looking for H. pylori bacterium or cancer will be taken. This, combined with a patient history, will form the diagnosis (Vakil 2022).

Preventing Peptic Ulcers

peptic ulcer taking painkillers
  • Protect from infection by washing hands well, practising good hygiene and avoiding eating foods that have not been properly cooked
  • Avoid overusing painkillers - if painkillers are required, they should be taken with meals.

(Mayo Clinic 2022)


Test Your Knowledge

Question 1 of 3

True or false: Peptic ulcers can be caused by eating spicy foods.


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