Peptic Ulcer: Causes, Symptoms, Treatment Options, and Complications

Introduction

Peptic ulcers are sores formed due to a discontinuity in the gastric mucosa, usually greater than 5 mm in diameter, and extending through the muscularis mucosa. The most common causes include increased gastric acid secretion and infection by Helicobacter pylori. Clinically, patients often present with a burning sensation and pain in the epigastric region. Treatment may involve proton pump inhibitors (PPIs), antacids, and antibiotics in case of H. pylori infection. If untreated, complications can include perforation, upper gastrointestinal (UGI) bleeding, and even malignancy.

What is Peptic Ulcer Disease (PUD)?

Peptic ulcer disease refers to the presence of gastric and/or duodenal ulcers. These ulcers commonly occur in the distal esophagus, stomach, and proximal duodenum. However, they can occasionally be found in the distal duodenum or proximal jejunum. Peptic ulcers result from a disruption in the mucosal lining that penetrates the muscularis mucosa, typically in a hyper acidic environment. Most ulcers are at least 5 mm in size.

Causes of Peptic Ulcer Disease

Common causes include:

• Use of NSAIDs (Non-Steroidal Anti-Inflammatory Drugs)

• Consumption of spicy and fried foods

• Smoking

• Alcohol intake

• Helicobacter pylori infection

Other, less common causes:

• Crohn’s disease

• Severe stress

• Malignancy

• Chemotherapy

• Radiation therapy

• Viral infections

• Vascular insufficiency

Symptoms of Peptic Ulcer Disease

Gastric Ulcers

• Dull or burning pain in the epigastric region

• Pain typically worsens after meals

• Nausea or vomiting

• Unintentional weight loss due to reduced food intake

  

  Image 1: A large, deep ulcer is seen in the prepyloric area with a visible vessel at its base.Image credit: Dr. Naveen Kumar.

Image 2: A geographical-shaped ulcer is seen along the lesser curvature in the antrum, involving the incisura, with active oozing from the base. Although the ulcer appeared malignant on endoscopy, the biopsy was positive for H. pylori. It healed following H. pylori eradication therapy.

Image credit: Dr. Naveen Kumar.

Image 3: A deep, clean-based ulcer is seen at the pylorus.

Image credit: Dr. Naveen Kumar.

Duodenal Ulcers

• Pain is relieved by meals and worsens on an empty stomach

• Patients may experience pain during the evening or nighttime

Diagnosis

Diagnosis typically begins with a thorough history and physical examination. The investigation of choice is Esophagogastroduodenoscopy (EGD), which allows direct visualization and biopsy for histological assessment.

For H. pylori detection, the following tests are available:

• Urea breath test

• Fecal antigen test

• Rapid urease test

• Serology

• Culture (used in resistant cases)

Note: The accuracy of these tests can be affected by prior use of PPIs or antibiotics.

Treatment Options

• Proton Pump Inhibitors (PPIs)

• H2-Receptor Blockers

• Antacids

• Lifestyle modifications: Avoiding NSAIDs, smoking, alcohol, and spicy foods

• For H. pylori-positive cases: Combination therapy using antibiotics (e.g., amoxicillin + clarithromycin) and PPIs for eradication.

In resistant cases, culture and sensitivity testing are recommended to guide antibiotic therapy.

Complications

• Bleeding

• Perforation

• Malignancy (especially in chronic, untreated gastric ulcers)

Case Presentation

A 22-year-old male presented with abdominal pain for the past hour, which worsened with movement. He had a similar episode earlier that morning and was treated for gastritis at a local hospital.

Examination Findings

• Patient alert and afebrile

• Blood Pressure: 96/60 mmHg

• Pulse: 118 bpm, regular

• Respiratory: Vesicular breath sounds

• Cardiac: Normal heart sounds, no murmurs

• Abdominal: Tenderness with tympanic on percussion

Given the clinical suspicion of a perforated peptic ulcer, an X-ray of the abdomen (erect view) was performed, revealing air under the diaphragm.

Image 4: Air under the diaphragm (red arrow) is visible in an erect abdominal X-ray of the patient.

Emergency surgery was done with omental patch closure of a prepyloric perforation, and the patient was successfully managed postoperatively.

Conclusion

Peptic ulcer disease is a common but potentially serious condition that arises from mucosal injury due to acid, infections, or external irritants like NSAIDs and alcohol. Prompt diagnosis and appropriate treatment—especially in the presence of H. pylori—can prevent complications like bleeding, perforation, and malignancy. Awareness of symptoms and early intervention play a vital role in patient outcomes. Clinicians should maintain a high index of suspicion, especially in recurrent abdominal pain cases, and manage patients comprehensively through medical therapy and, when necessary, surgical intervention.

Dr Naveen Kumar

About the Author

Dr. Naveen Kumar, MBBS, MD, DM (Gastroenterology, PGIMER Chandigarh)Director, Department of GastroenterologySri Harihar Hospital and Research Center, Gutkar, District Mandi, Himachal Pradesh

Dr. Naveen Kumar is a highly respected gastroenterologist with advanced training from the prestigious PGIMER, Chandigarh. As the Director of the Department of Gastroenterology at Sri Harihar Hospital and Research Center, he brings exceptional expertise in diagnosing and managing a wide spectrum of digestive disorders, with a strong focus on advanced endoscopic techniques.

He is the first and only gastroenterologist in Himachal Pradesh performing endoscopic ultrasound (EUS) and cutting-edge procedures like Peroral Endoscopic Myotomy (POEM) for achalasia cardia, setting new standards in gastrointestinal care across the region.

Renowned for his patient-centered care and commitment to clinical excellence, Dr. Naveen also plays an active role in medical education and public awareness through his writings and academic contributions.

He is the editor of this article, and all endoscopic images included are credited to him.

📧 Email: contact@drnaveenkumargastro.com🐦 Twitter: @drnaveenm