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Peptic Ulcer Disease

Learn about peptic ulcer disease, including its symptoms, diagnosis, laboratory tests, treatment and prevention.

Last Reviewed 30 Jul 2026
Reading Time 8 min read

Overview

A burning pain in the upper stomach, often worse on an empty stomach or in the middle of the night, is the classic sign of a peptic ulcer. What surprises many people is that the most common cause is not stress or spicy food, as was long believed, but a common, treatable bacterial infection.

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Key Fact

For most of the 20th century, doctors believed peptic ulcers were caused by stress, spicy food, and stomach acid alone, and treated them with medication for life. The discovery that a bacterium, Helicobacter pylori, actually causes most ulcers, and that a course of antibiotics can cure them, won its discoverers a Nobel Prize.

Warning

Vomiting blood, black or tarry stools, or sudden, severe abdominal pain are signs of a serious ulcer complication and need emergency care immediately.

AT A GLANCE

Disease Summary

Category Infectious Disease
Cause Most often infection with Helicobacter pylori bacteria; also caused by long-term use of NSAID pain medications
Transmission H. pylori spreads through contaminated food or water, and close contact such as sharing utensils; ulcers caused by NSAID use are not infectious
Body System Digestive System
Preventable Yes
Curable Yes

Symptoms

Common Symptoms

Some people with a peptic ulcer have no symptoms at all. When symptoms occur, they typically include the following.

Burning Stomach Pain

Often felt in the upper abdomen, and classically worse when the stomach is empty, such as at night or between meals.

Bloating

A feeling of fullness or bloating can accompany the discomfort.

Nausea

Can occur alongside the pain, particularly after eating.

Heartburn

A burning sensation that can extend up toward the chest.

Discomfort After Eating

Some people notice their pain worsens, rather than improves, after meals.

Danger Signs

Seek emergency medical attention immediately if any of the following develop.

Vomiting Blood or Dark, Coffee-Ground-Like Vomit

A sign of active bleeding from the ulcer and needs emergency care.

Black or Tarry Stools

Indicates bleeding higher in the digestive tract and needs urgent medical attention.

Sudden, Severe Abdominal Pain

Can indicate the ulcer has perforated the stomach or intestinal wall, a surgical emergency.

Feeling Faint or Dizzy

Can indicate significant blood loss and needs prompt evaluation.

Diagnosis

Clinical History

Doctors ask about the pattern of pain, medication use, particularly NSAIDs, and any family history of ulcers.

H. pylori Testing

A breath, stool, or blood test can detect this bacterium, the leading cause of peptic ulcers.

Upper Endoscopy

A thin, flexible camera is used to directly examine the stomach and duodenum, confirm the ulcer, and take a tissue sample if needed.
Important
Because both an active infection and a healed one can sometimes give similar test results, doctors often use more than one type of test to confirm whether H. pylori is currently present.

Laboratory Tests

Urea Breath Test

Detects an active H. pylori infection by measuring a substance the bacteria produce.

Sample Breath sample, after swallowing a special solution
Time Within an hour

Stool Antigen Test

Detects H. pylori proteins in the stool and is commonly used both to diagnose infection and to confirm it has been cleared after treatment.

Sample Stool
Time 24–48 hours

Blood Antibody Test

Checks for antibodies to H. pylori, though it cannot distinguish between a current and a past infection.

Sample Venous blood
Time 24–48 hours

Upper Endoscopy with Biopsy

Allows direct visual examination of the ulcer and testing of a tissue sample for H. pylori.

Sample Tissue sample, taken during endoscopy
Time A few days

Laboratory Note

A blood antibody test can stay positive long after an infection has cleared, so a breath or stool test is generally preferred for confirming whether H. pylori has actually been cured.

Treatment

H. pylori Eradication Therapy

A combination of antibiotics and an acid-reducing medication clears the infection and allows the ulcer to heal, significantly reducing the chance it will return.

Route Oral
Duration 10 to 14 days

Acid-Reducing Medication

Reduces stomach acid to allow the ulcer to heal, used for ulcers caused by NSAIDs as well as those caused by H. pylori.

Route Oral
Duration Several weeks, or longer if NSAIDs must continue

Treatment Note

Successfully treating H. pylori infection cures the underlying cause of most peptic ulcers, unlike older approaches that only managed symptoms. Confirming the infection is actually gone, rather than assuming treatment worked, is an important final step.

Prevention

Practise good hygiene

Regular handwashing and avoiding sharing utensils or cups can reduce the spread of H. pylori.

Use NSAIDs cautiously

Using the lowest effective dose for the shortest time needed, or taking a protective medication if long-term use is necessary, lowers ulcer risk.

Avoid smoking

Smoking slows ulcer healing and increases the risk of complications.

Limit alcohol

Heavy alcohol use can irritate the stomach lining and interfere with healing.

Prevention Note

Testing and treating H. pylori, even in people without symptoms in some cases, is an important part of preventing peptic ulcers in regions where the infection is common.

Risk Factors

Higher Risk

These factors are the leading causes of peptic ulcer disease.

  • H. pylori infection
  • Regular or long-term use of NSAIDs, such as aspirin or ibuprofen

Contributing Factors

These factors increase the risk or slow healing of peptic ulcers.

  • Smoking
  • Heavy alcohol use
  • Older age

Additional Considerations

Less common but important contributing factors.

  • A family history of peptic ulcers
  • Severe physical stress, such as critical illness or major injury

Risk Note

H. pylori infection remains more common in regions with limited access to clean water and sanitation, which is part of why peptic ulcer disease continues to be common in many parts of the world even as it has declined elsewhere.

Complications

Bleeding

The most common serious complication, ranging from slow, ongoing blood loss to sudden, severe bleeding.

Perforation

A hole through the stomach or intestinal wall is a surgical emergency that can lead to a serious abdominal infection.

Gastric Outlet Obstruction

Scarring from repeated ulceration can narrow the passage out of the stomach, causing persistent vomiting.

Complication Note

Long-term, untreated H. pylori infection also increases the risk of stomach cancer, which is one of the reasons testing and treating the infection matters even beyond healing a current ulcer.

When to Seek Medical Care

Vomiting Blood or Dark, Coffee-Ground-Like Vomit

Needs emergency medical attention.

Black or Tarry Stools

Needs urgent medical evaluation.

Sudden, Severe Abdominal Pain

Can indicate a serious complication and needs emergency care.

Persistent Stomach Pain Despite Over-the-Counter Antacids

Should be evaluated by a healthcare provider rather than managed indefinitely on your own.

Emergency Advice

Ongoing stomach pain that keeps you reaching for antacids is worth a proper evaluation. Peptic ulcers are very treatable, and the underlying cause, not just the discomfort, deserves to be addressed.

Prognosis

Excellent With Appropriate Treatment

Most peptic ulcers heal completely within a few weeks once the underlying cause is treated.

Recurrence Is Uncommon After Successful H. pylori Treatment

Confirmed eradication of the infection significantly reduces the chance of a new ulcer developing.

Untreated Ulcers Can Lead to Serious Complications

Ongoing bleeding, perforation, or obstruction can develop if the underlying cause is not addressed.

Prognosis Note

Peptic ulcer disease is one of the clearer examples in medicine of a condition that was once treated as a lifelong, chronic problem but is now, in most cases, genuinely curable.

Differential Diagnosis

Gastritis

Inflammation of the stomach lining without a distinct ulcer, sometimes caused by the same factors as peptic ulcers.

Gastroesophageal Reflux Disease (GERD)

Causes heartburn and discomfort but arises from acid moving up into the oesophagus rather than a break in the stomach or duodenal lining.

Gallbladder Disease

Can cause upper abdominal pain that is sometimes mistaken for a peptic ulcer, particularly after fatty meals.

Clinical Note

Because these conditions can feel similar, and because peptic ulcer symptoms can also occasionally signal something more serious, persistent symptoms are worth having properly evaluated rather than self-diagnosed.

References

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) — Diagnosis

Clinical guidance on diagnosing peptic ulcers and identifying their underlying cause.

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) — Treatment

Clinical guidance on treating peptic ulcers, including H. pylori eradication therapy.

World Gastroenterology Organisation Global Guidelines: Helicobacter pylori

Global clinical guidelines on H. pylori diagnosis, treatment, and its role in peptic ulcer disease worldwide.

Frequently Asked Questions

Can peptic ulcers be cured?
Yes, in most cases. When H. pylori infection is the cause, a course of antibiotics along with acid-reducing medication cures the underlying infection and allows the ulcer to heal, greatly reducing the chance it comes back.
Is H. pylori contagious?
Yes. It spreads through contaminated food or water, and through close contact such as sharing utensils, most often within families.
Do spicy foods cause ulcers?
No, though they can sometimes worsen symptoms in people who already have an ulcer. The two leading causes are H. pylori infection and long-term use of NSAID pain medications.
Can I take ibuprofen if I've had an ulcer before?
This is worth discussing with a doctor. If NSAIDs are necessary, a protective medication can sometimes be used alongside them to reduce the risk of another ulcer.