Peptic ulcer

A peptic ulcer (gastric ulcer, duodenal ulcer) is a defect in the gastric mucosa. Surface defects are described as erosion; deeper mucosa defects as an ulcer. Infection with the helicobacter pylori bacterium and intake of anti-inflammatory medication are the most common cause of a peptic ulcer. Peptic ulcers are usually treated without medication. Surgical treatment is only required in exceptional cases.

The gastric mucosa is normally protected against the aggressive, acidic stomach acid. Different factors maintain a balance between protecting the gastric mucosa and the acid level of the stomach acid. If this balance is upset, whether through increased stomach acid production or loss of the protective function, peptic ulcers can occur. The most common causes for impairment of the protective function are infections with helicobacter pylori bacteria or the intake of non-steroidal anti-inflammatory drugs. These medications are often prescribed for pain, chronic inflammation or rheumatic illness. If they have to be taken over a longer period of time, additional acid blockers can also be prescribed to protect the stomach.

Psychological stress as well as chronic nicotine or alcohol consumption can facilitate the occurrence of a peptic ulcer; however, they are not usually the only causes.

A peptic ulcer can manifest in different ways, depending on the severity of the disease. The patient typically experiences dull or burning pain in the abdominal area. If the ulcer is gastric in nature, this pain is usually intensified by food; however, in the case of a duodenal ulcer (ulcus duodeni), the pain is often alleviated by eating.  A feeling of fullness, heartburn, flatulence, nausea and vomiting can be further symptoms of a peptic ulcer. In serious cases, when the ulcer extends into the abdominal wall or breaches it, there may be haemorrhaging. This can manifest as bloody vomit or as black discolouration in the stool. Such symptoms should therefore be clarified immediately by a doctor.

The patient’s medical history and symptoms already often suggest that they are suffering from a peptic ulcer. The diagnosis is confirmed with a gastroscopy. The search for helicobacter pylori bacteria is always also part of the examination. There are different tests such as a breath test, stool examination, gastric biopsy or blood examination available to detect helicobacter pylori infection.

Nowadays, medical treatment is usually sufficient to cure a peptic ulcer. Medications which reduce stomach acid production are used to this end. An infection with helicobacter pylori is also treated with antibiotics. Surgery is only necessary if there is perforation of the stomach or severe bleeding. Find out more about the surgical treatment options in the Gastric surgery section.