Peptic Ulcer Disease

Peptic ulcer disease is a sore in the lining of the stomach or the first part of the small intestine (duodenum), most commonly caused by Helicobacter pylori infection or long-term use of non-steroidal anti-inflammatory drugs (NSAIDs).

• Burning or gnawing pain in the upper abdomen, often related to meals
• Bloating and nausea
• Alarm features requiring urgent referral: vomiting blood, black tarry stools, unexplained weight loss, or difficulty swallowing

• Helicobacter pylori infection.
• Regular use of NSAIDs or aspirin.
• Excessive alcohol use and smoking.
• Stress alone is not considered a primary cause, though it can worsen symptoms.

• Mainly clinical, based on the pattern of symptoms.
• Where available, testing for H. pylori (stool antigen test or urea breath test).
• Upper endoscopy, particularly for patients with alarm features or those who fail initial treatment.

Uncomplicated peptic ulcer disease is treated with a proton pump inhibitor, such as omeprazole, for 4–8 weeks to reduce stomach acid and allow the ulcer to heal.

Where H. pylori infection is confirmed or strongly suspected, eradication therapy combining a proton pump inhibitor with two antibiotics — commonly amoxicillin and metronidazole, or clarithromycin — is given for 7–14 days.

NSAIDs should be stopped or minimised wherever possible.

Patients with bleeding, perforation, or suspected malignancy are referred urgently for hospital-level and, where needed, surgical management.

• Avoid unnecessary use of NSAIDs.
• Limit alcohol consumption.
• Avoid smoking.
• Complete the full course of H. pylori eradication treatment when prescribed.