Peptic Ulcers

An "ulcer" is a break in the lining of an organ's surface; it usually means a break that has been present for some time. Peptic ulcer is the general term to describe an ulcer in the lining of the stomach (gastric) or duodenum (the first part of the small intestine forming the outlet of the stomach).

Peptic ulcers are not cancers, although a cancer can present as an ulcer.

Cause of Peptic Ulcers

Duodenal ulcers are usually caused by a combination of factors - helicobacter pylori infection (see Index), acid production by the stomach, and impaired resistance of the duodenum to acid.

The cause of gastric (stomach) ulcers is less certain. However, it is known that non-steroidal anti-inflammatory drugs (NSAIDS) and aspirin are a common cause of ulcers in the stomach and duodenum.


Peptic ulcers may cause a number of symptoms including indigestion, loss of appetite, nausea, vomiting and weight loss. Less common symptoms include bleeding (either vomiting of blood or passage of blood from the bowel - the latter is usually black and is called melaena).

Very rarely an ulcer can cause a hole to develop in the wall of the stomach or duodenum, allowing food and gastric secretions to enter the abdominal cavity - this is known as a perforated ulcer and is a surgical emergency.


Diagnosis of peptic ulcer can be made by endoscopy, or very rarely by double-contrast barium meal examination. The preferred investigation is endoscopy because it is more accurate and has the advantage that biopsies can be taken at the same time. Urea breath testing (or endoscopy) can accurately determine if the patient has a helicobacter pylori infection.

Medical Treatment

Peptic ulcers are treated by: (1) reducing acid secretion (2) treating helicobacter pylori infection, and (3) stopping NSAIDS.

Acid secretion is reduced with proton pump inhibitors (e.g. esomeprazole). Surgery - highly selective vagotomy - can also achieve this.

Other Treatment

Some lifestyle changes may be necessary for treating peptic ulcer. For instance, cigarette smoking may prolong ulcer healing and therefore smoking should be ceased. There is little role for dietary modification, although any foods which cause the symptoms to occur should be avoided. Excessive alcohol consumption should be avoided.