Peptic Ulcer Disease (PUD)

Peptic ulcers are breaks that extend through the mucosa, typically occurring in the stomach or in the duodenum. The two primary causes of peptic ulcers are infection with a bacteria known as Helicobacter pylori or the use of nonsteroidal anti-inflammatory medications such as aspirin, ibuprofen or naproxen.  Smoking has also been associated with increased risk of PUD. Stress and diet were initially thought to predispose to PUD, but now are recognized to be of little or no risk.

In the United States over 4 million patients develop PUD each year with the majority of the ulcers healing without complications. Still serious complications such as bleeding, perforation or obstruction can occur.

Peptic ulcer disease may be asymptomatic or present with pain/discomfort in the upper abdomen, nausea, vomiting (potentially with blood) or stools that are black and tar like with a foul odor.  Duodenal ulcer classically manifests with pain that is “gnawing” in quality in the upper abdomen and worse with fasting. Gastric ulcer, on the other hand classically has pain in the same location but is worsened with meals.

The symptoms of PUD may be seen in other conditions such as acid reflux disease, functional dyspepsia, slowed emptying of the stomach (gastroparesis), symptomatic gallstones or inflammation of the gallbladder and less commonly gastric cancer.

The most common method used to detect PUD is upper endoscopy (flexible scope with camera at tip that is used to examine the esophagus, stomach and duodenum). Your Borland-Groover Clinic provider will best be able to determine if endoscopy is indicated for you. In cases of weight loss, anemia (low red blood cell counts), or persistent upper abdominal pain, it is likely endoscopy will be recommended

Helicobacter pylori testing is often performed in those with symptoms of PUD, particularly if a gastric or duodenal ulcer is confirmed during endoscopy.

Once PUD is identified, a careful history focusing on the use of non-steroidal anti-inflammatory medications or tobacco use should be obtained. If Helicobacter pylori is identified in testing a 7-14 day treatment with acid blocking medications and antibiotics is likely to be prescribed. These regiments are successful in eradicating Helicobacter pylori infection in about 90% of those treated. If non-steroidal anti-inflammatory medications are required your provider may chose to use an acid blocker known as a proton pump inhibitor in combination with the non-steroidal anti-inflammatory drug or may choose a non-steroidal anti-inflammatory durg less associated with PUD (celebrex for example).

In the case of gastric ulcers, it is recommended that repeat endoscopy be performed 6-8 weeks after the initial diagnosis to confirm healing of the ulcer and to rule cancer as the cause of the ulceration.

For more information visit the National Library of Medicine


1. Graham, DY. Nonsteroidal anti-inflammatory drugs, Helicobacter pylori, and ulcers: Where we stand? Am J Gastroenterol 1996; 91:2080. 
2. Kochman, ML, Elta, GH. Gastric ulcers — when is enough, enough. Gastroenterology 1993; 105:1583. 
3. Chey, WD, Wong, BC. American College of Gastroenterology guideline on the management of Helicobacter pylori infection. Am J Gastroenterol 2007; 102:1808. 
4. Peura, DA, Goldkind, L. Balancing the gastrointestinal benefits and risks of nonselective NSAIDs. Arthritis Res Ther 2005; 7 Suppl 4:S7.