Peptic ulcer disease causes open sores in your stomach lining or duodenum (the top of your small intestine). The condition causes open sores – called ulcers – develop in the lining of your digestive tract. The prefix “peptic” denotes that it is related to digestion. 
 
Pepsin and stomach acid are your stomach’s active ingredients to chemically break down the food consumed so it can be digested. Some of these juices also pass into the first part of your small intestine (duodenum). By design, these juices are very corrosive. 
 

The entire length of your GI tract is protected with a mucous lining that insulates it from its contents. This lining is especially thick in your stomach and duodenum. However, in peptic ulcer disease, this protection fails, and digestive juices corrode through the lining. 
 
Most peptic ulcers occur in your stomach or duodenum, where the gastric juices are most active. They are less frequently found elsewhere in your GI tract. 

According to PLOS ONE, peptic ulcer disease (PUD) affects four million people worldwide annually and has an estimated lifetime prevalence of 5−10% in the general population. 
 
Age and Gender Factors: 
PUD can strike at any age; duodenal ulcers affect mainly younger adults. The majority of people who are afflicted by gastric ulcers are older than 60. Men are somewhat more susceptible, though more recent lifestyle factors are increasingly causing the condition to afflict more females. 
 

What are the categories of peptic ulcers? 
Peptic ulcer disease most commonly affects your stomach and duodenum. 

• Duodenal ulcers account for almost 80% of peptic ulcers. 

• Stomach ulcers account for almost 20% of peptic ulcers. 

You can get a peptic ulcer elsewhere in your gastrointestinal tract under unusual circumstances that cause stomach juices to pass through those parts. For example: 

• Oesophageal ulcer: Chronic acid reflux, stomach acid rising into your oesophagus, may eventually erode the mucous lining in your oesophagus enough to cause an ulcer. Your oesophagus lining isn’t as protected against acid as your stomach lining is. 

• Jejunal ulcer: You can develop an ulcer in your middle portion of your small intestine, which is known as your jejunum, as a complication of surgery that connects your stomach to your jejunum (gastrojejunostomy). It is also referred to as a stomal ulcer, marginal ulcer or anastomotic ulcer. 

Symptoms of PUD:  
 
Up to 70% of people with peptic ulcer disease do not have noticeable symptoms. The most common ones are upper abdominal pain (epigastric pain) and indigestion (dyspepsia), which can come and go. 
 
Indigestion includes burning pain, a feeling of fullness after eating, and discomfort that can last a while. This burning is due to stomach acids damaging the gastrointestinal lining. Some people also experience a gnawing sensation in a specific spot. 
 
Oesophageal ulcers tend to present as heartburn, especially at night. Duodenal ulcers usually worsen 2-3 hours after eating, often relieved by eating: the pain is typically located in the midepigastric region. Nighttime pain also may be caused by duodenal or jejunal ulcers, which have an uncomfortable sensation of lower epigastric pain. 
 
 
Other possible signs and symptoms of peptic ulcer disease include: 

• Distended abdomen 

• Regurgitation or belching 

• Loss of appetite 

• Vomiting 

Symptoms of complications:  
Other people may not experience any symptoms before peptic ulcer disease presents other complications. This may happen when ulcers are left untreated for too long. The uncontrolled ulcers will begin bleeding or may continue to wear away your GI tract until an opening is formed. 
 

Upper GI bleeding signs and symptoms may range from: 

• Passing blood in your stool 

• Black, tarry stool 

• Coffee ground vomitus 

• Dizziness or faintness 

• Paleness (Pallor) 

• Elevated pulse rate (Tachycardia) 
   

Gastrointestinal perforation signs and symptoms may include: 

• Acute, severe abdominal pain 

• Abdomen distended or tender to palpation 

• Fever and chills. 

This can cause ulcers to repeatedly heal and then re-emerge. In some people, untreated peptic ulcer disease leads to widespread scarring and/or swelling in the GI tract, which can impede food movement and also lead to increased risk of gastric cancer. 
 

Constriction or obstruction of the gastrointestinal tract may involve any or all of the following: 

• Abdominal bloating and distension and pain. 

• Nausea and vomiting. 

• Loss of appetite and weight loss. 

• Bowel movements cessation and constipation. 

What causes peptic ulcer disease? 
 
When something damages the protective mucous lining of the stomach or duodenum, it leads to peptic ulcer disease. The two main causes are:  
 
H. pylori infection: A common bacteria that induces chronic inflammation and weakening of the lining. 
Overuse of NSAIDs (nonsteroidal anti-inflammatory drugs): NSAIDs are common over the counter (OTC) pain relievers, including pain medications such as aspirin and ibuprofen which interfere with healing of the lining. 
 
Other less common causes include infections, ischemia resulting from reduced blood flow, extreme stress, chemotherapy, and other conditions, such as Crohn’s disease or Zollinger-Ellison syndrome. Ulcers may also be caused by chronic acid reflux or gastric bypass surgery in the stomach or oesophagus. 
 
What are the risk factors for peptic ulcer disease? 
You are at higher risk of developing PUD if you harbour an H. pylori infection or if you frequently use NSAIDs, particularly if both are present. 
 
Other potential contributory factors include smoking, alcohol use and other medications you may be on. 

 
Treatment Options:  
The good news is that PUD can be treated. Medications can cure the infections and further heal the ulcers. These include: 
 
Medications: Antibiotics to treat infections and acid blockers to treat the ulcers. 
Lifestyle Changes: Smoking cessation, alcohol reduction, and healthy diet. 
Follow-up: Regular follow up with your health care provider.