Beyond Stomach Pain: What You Need to Know About Peptic Ulcer Disease
Table of Contents
A peptic ulcer forms when the protective lining of the stomach or duodenum gets damaged, allowing acid to create an open sore [3]. It often feels like a burning pain in the upper belly. Sometimes the pain comes and goes, and sometimes it gets worse after eating certain foods—spicy or acidic ones are frequent offenders.
But here's the kicker: not everyone with an ulcer feels it. About two-thirds of patients have no obvious symptoms [2], which makes early detection tricky. Older adults especially may not get classic stomach pain, which means ulcers in this group often aren't found until they've done serious damage [7].
Forget the old wives' tales—stress or spicy food alone won't give you an ulcer. The real causes usually fall into two main categories:
Other risk factors include smoking, heavy alcohol use, certain other medications (like steroids or blood thinners), and rare conditions like Zollinger-Ellison syndrome, which causes the stomach to produce too much acid [8].
Most people with peptic ulcers describe a burning or gnawing pain in the upper abdomen. Others might experience bloating, nausea, or indigestion. If the ulcer starts to bleed, it can become a medical emergency, requiring immediate attention. If the ulcer starts to bleed, symptoms become more alarming—black or bloody stools, vomit that looks like coffee grounds, or sudden dizziness are all red flags [12].
Worse yet, ulcers can lead to serious complications:
Doctors usually start with non-invasive tests if they suspect H. pylori. These include stool, breath, or blood tests, with the urea breath test being a common method to detect H. pylori. For patients with more serious or 'alarm' symptoms (like unexplained weight loss or vomiting blood), upper endoscopy is often the next step [5], [9].
Younger patients with mild symptoms are often treated using a 'test-and-treat' strategy that targets H. pylori directly [6].
If H. pylori is the culprit, treatment typically involves a mix of antibiotics and acid-reducing medication. Proton pump inhibitors (PPIs) like omeprazole are the go-to drugs—they lower acid levels so ulcers can heal. These are also effective for ulcers not caused by H. pylori [14].
But long-term PPI use raises concerns. Research has linked extended use to issues like kidney damage and nutrient deficiencies, which is why newer treatments are gaining traction.
Vonoprazan is a potassium-competitive acid blocker (PCAB) that works faster and may be more effective than PPIs [11]. It provides strong, long-lasting acid control and is gaining attention as a promising option—especially as H. pylori grows more resistant to common antibiotics [10].
Today's peptic ulcer cases aren't always as straightforward as they used to be. Here's what's changing:
These shifts are forcing healthcare providers to adapt, especially in the context of gastrointestinal and liver disease. Newer strategies for screening, treating, and monitoring high-risk patients are becoming the norm.
Definitely. Lifestyle changes go a long way to prevent peptic ulcers. Avoiding unnecessary NSAID use, quitting smoking, limiting alcohol, and managing stress are great starting points. Eating a balanced diet and checking in with your doctor for recurring stomach issues can help catch ulcers early—before complications set in.
If you've already been diagnosed, sticking with your treatment plan and attending regular follow-ups are essential. Many ulcers can be healed with proper care, but preventing recurrence is just as important as treating the first episode.
Peptic ulcer disease might not grab headlines like it used to, but it's still a major player in digestive health. With better hygiene, smarter treatments, and a growing understanding of its causes, we're in a much better place than we were a few decades ago. But the rise of treatment-resistant bacteria, aging populations, and unexplained ulcer cases means we've got more work to do. Treating H. pylori is crucial not only for ulcer management but also to reduce the risk of stomach cancer.
References
1. Vakil N. (2024). Peptic Ulcer Disease: A Review. JAMA, 332(21), 1832–1842. https://doi.org/10.1001/jama.2024.19094
2. Kavitt, R. T., Lipowska, A. M., Anyane-Yeboa, A., & Gralnek, I. M. (2019). Diagnosis and Treatment of Peptic Ulcer Disease. The American journal of medicine, 132(4), 447–456. https://doi.org/10.1016/j.amjmed.2018.12.009
3. Tuerk, E., Doss, S., & Polsley, K. (2023). Peptic Ulcer Disease. Primary care, 50(3), 351–362. https://doi.org/10.1016/j.pop.2023.03.003
4. Almadi, M. A., Lu, Y., Alali, A. A., & Barkun, A. N. (2024). Peptic ulcer disease. Lancet (London, England), 404(10447), 68–81. https://doi.org/10.1016/S0140-6736(24)00155-7
5. Ramakrishnan, K., & Salinas, R. C. (2007). Peptic ulcer disease. American family physician, 76(7), 1005–1012. https://pubmed.ncbi.nlm.nih.gov/17956071/
6. Bailey J. M. (2024). Gastrointestinal Conditions: Peptic Ulcer Disease. FP essentials, 540, 16–23. https://pubmed.ncbi.nlm.nih.gov/38767885/
7. Najm W. I. (2011). Peptic ulcer disease. Primary care, 38(3), 383–vii. https://doi.org/10.1016/j.pop.2011.05.001
8. Narayanan, M., Reddy, K. M., & Marsicano, E. (2018). Peptic Ulcer Disease and Helicobacter pylori infection. Missouri medicine, 115(3), 219–224. https://pubmed.ncbi.nlm.nih.gov/30228726/
9. Dore, M. P., & Graham, D. Y. (2008). Gastritis, dyspepsia and peptic ulcer disease. Minerva medica, 99(3), 323–333. https://pubmed.ncbi.nlm.nih.gov/18497728/
10. Lanas, A., & Chan, F. K. L. (2017). Peptic ulcer disease. Lancet (London, England), 390(10094), 613–624. https://doi.org/10.1016/S0140-6736(16)32404-7
11. McConaghy, J. R., Decker, A., & Nair, S. (2023). Peptic Ulcer Disease and H. pylori Infection: Common Questions and Answers. American family physician, 107(2), 165–172. https://pubmed.ncbi.nlm.nih.gov/36791443/
12. Mynatt, R. P., Davis, G. A., & Romanelli, F. (2009). Peptic ulcer disease: clinically relevant causes and treatments. Orthopedics, 32(2), 104. https://pubmed.ncbi.nlm.nih.gov/19301796/
13. Malfertheiner, P., Chan, F. K., & McColl, K. E. (2009). Peptic ulcer disease. Lancet (London, England), 374(9699), 1449–1461. https://doi.org/10.1016/S0140-6736(09)60938-7
14. Brooks F. P. (1985). The pathophysiology of peptic ulcer disease. Digestive diseases and sciences, 30(11 Suppl), 15S–29S. https://doi.org/10.1007/BF01309381
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