Peptic Ulcer Disease Treatment Guidelines

Medically reviewed by: Eiman Firoozmand, MD

Peptic ulcer disease (PUD) affects 6 million people in the US each year. If you’ve been experiencing abdominal pain, indigestion, nausea, vomiting, or bloating, you may have PUD. 

Read ahead to learn about what PUD is, how it’s diagnosed, and what the latest peptic ulcer treatment guidelines recommend.

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What is peptic ulcer disease (PUD)?

PUD is a common gastrointestinal disorder that occurs when stomach acid and digestive enzymes erode the lining of the stomach or the duodenum.

The duodenum is the first part of the small intestine, and its closeness to the stomach makes it vulnerable to damage by stomach acid.

When acid damages the lining of the stomach or duodenum, patients may experience:

  • Burning pain in the upper abdomen
  • Belching
  • Indigestion
  • Nausea
  • Vomiting
  • Bloating — or a feeling of excessive gas in the digestive tract 

It’s important to note that 70% of patients with gastric and duodenal ulcers don’t experience any symptoms.

Instead, they may only be diagnosed incidentally through an endoscopic procedure for another problem. In other cases, they may present with a complication of PUD, such as perforation or a bleeding peptic ulcer.

Perforation refers to a tear in the stomach or duodenum, which can cause a severe abdominal infection. Peptic ulcer bleeding means that blood vessels have been damaged and leak blood into the digestive tract. Bleeding ulcers can show up as black-colored (or tarry) stools. 

In both these cases, the condition is known as complicated peptic ulcer disease.

What causes peptic ulcer disease?

A Helicobacter Pylori infection and the use of nonsteroidal anti-inflammatory drugs (NSAIDs) are the two major causes of PUD.

  1. pylori is a type of bacteria that can survive in the acidic environment of the stomach. It’s estimated that up to 70% of duodenal ulcers and 50% of gastric ulcers are caused by H. pylori. 

When this bacterium infects the stomach lining, it leads to the production of excess acid, leading to the formation of an ulcer.

On the other hand, NSAIDs reduce the production of prostaglandins, which are protective compounds that help keep the stomach lining healthy. 

When these compounds aren’t produced in large enough quantities, the stomach lining is left vulnerable to damage from excessive acid.

Keep in mind that H. pylori and NSAIDs don’t cause peptic ulcers on their own. Instead, they combine with other risk factors, such as smoking and alcohol use, to create an environment in which PUD can occur.

In addition, there are many other rarer causes of PUD, including:

  • Non-NSAID drugs like acetaminophen, steroids, and antidepressants
  • Infections like cytomegalovirus (CMV), herpes simplex virus (HSV-1), and Epstein-Barr virus (EBV)
  • Radiation
  • Illicit drugs like cocaine
  • Surgery

How to diagnose peptic ulcer disease?

PUD can be diagnosed with history taking and investigations.

During history-taking, your healthcare provider will ask you about your symptoms as well as any risk factors for PUD you may have. 

They will also ask you about any alarm symptoms — such as weight loss, difficulty in swallowing, and a family history of gastric cancer.

If you’re under 60 years of age and don’t have any alarm symptoms, your doctor may order a test for determining your H. pylori infection status. This can include:

  • A urea breath test, where you drink a liquid containing urea and then your breath is tested for molecules that indicate the presence of H. pylori.
  • Fecal antigen test, where a stool sample is tested for the presence of H. pylori antigens.

On the other hand, if you’re over 60 years of age or have any alarm symptoms, regardless of age, your healthcare provider will refer you for an endoscopy. This is where a camera is inserted down your throat to look at the lining of the stomach and duodenum.

It’s important to note that endoscopy is the only way to definitively diagnose PUD (just like a colonoscopy is the only way to diagnose colon cancer). The other tests can only tell you if you have an H. pylori infection or not.

In addition, your doctor may take a biopsy during the endoscopy procedure to rule out cancer. 

A biopsy removes a small piece of tissue from the lining of the stomach or duodenum, which is then analyzed under a microscope. This is important because ulcers can also cause cancer.

What are the treatment options for peptic ulcer disease?

There are three main treatment options for PUD, including lifestyle changes, medication, and surgery.

Lifestyle changes

Making changes to your lifestyle is an important — and often the first — part of managing PUD. 

This can include quitting smoking, stopping NSAIDs or steroids, avoiding alcohol, and reducing stress levels

It’s also important to eat a balanced diet that is low in fat and processed foods while still providing adequate nutrition.


If lifestyle changes don’t work, drugs are the next step. If your doctor finds you have an H. pylori infection, they will give you drugs to eradicate these bacteria. This is called Helicobacter Pylori eradication therapy and usually includes 3 drugs:

  • A proton pump inhibitor, such as omeprazole, to reduce stomach acid production
  • Two antibiotics, such as clarithromycin and amoxicillin

The antibiotics you get can vary depending on how resistant H. pylori is in your area, but the duration of treatment usually remains constant at 10-14 days.

If you test negative for H. pylori, your doctor may prescribe you only an acid-suppressing drug (like a PPI) for 4-8 weeks, depending on the location of your ulcer.

In addition, you might also be asked to use antacids and cytoprotective agents like sucralfate, which promote ulcer healing and prevent further damage.


In rare cases, surgical treatment may be needed if the ulcer doesn’t respond to lifestyle changes and medications. Surgery is usually only considered if:

  • PUD leads to complications, such as recurrent bleeding or a perforated peptic ulcer
  • You have a disease that requires you to keep taking NSAIDs, such as ankylosing spondylitis
  • You can’t tolerate medications like proton pump inhibitors

In all these cases, you may have to undergo one of these procedures:

  • Vagotomy: This is a procedure to remove the nerve in your stomach that’s responsible for producing acid. It can be done either as an open surgery or laparoscopically.
  • Partial gastrectomy: This involves removing part of your stomach that has the ulcer. You may get a Billroth 1 operation (for duodenal ulcers) or Billroth 2 operation (for gastric ulcers).
  • Total gastrectomy: This is when the entire stomach is removed. This procedure is usually only done if you have cancer.

The type of procedure you get will depend on factors such as the location of your ulcer and your overall health. 

Your doctor will discuss these options with you to help you decide which one is best for you. But most cases of PUD respond to medical treatment, so there’s no need to worry.


Below is a list of the common questions we hear on this topic.

What foods to avoid with peptic ulcer disease?

It’s best to avoid high-fat, processed, and fried foods, as well as spicy, acidic, or fatty items. You should also limit your intake of caffeine and alcohol, as these substances can irritate the lining of your stomach.

Can peptic ulcer disease cause diarrhea?

Yes, PUD can cause diarrhea in some cases. This is usually due to the irritation of the lining of your digestive tract by stomach acid, which can lead to inflammation and irritation in the intestines. 

If you experience any changes in your bowel habits, it’s important to talk to your doctor to determine the cause.

Can peptic ulcer disease be cured?

Yes, PUD can often be cured with lifestyle changes and medications. If lifestyle changes and medications don’t work, surgery may be necessary. 

However, it’s important to note that no matter what treatment you receive, it’s important to follow up with your doctor to ensure the ulcer has healed and there are no further complications.

How common is peptic ulcer disease?

PUD affects 6 million people in the US each year. Fortunately, the number of people affected by this disease is decreasing, as we can now easily diagnose and treat H. pylori infections.

Does peptic ulcer disease go away on its own?

No, peptic ulcer disease usually doesn’t go away on its own. That’s why it’s important to seek medical attention if you are experiencing any symptoms. Remember, PUD is usually caused by an infection (H. Pylori), which will need antibiotics to cure.

How to prevent peptic ulcer disease?

Peptic ulcer disease can be prevented by practicing good hygiene. That’s because H. pylori, the bacteria that cause the infection, can be passed on through contaminated food and water. 

So it’s best to wash your hands often and avoid eating food from places that aren’t hygienic. Avoiding certain medications, such as NSAIDs and steroids, can also help reduce your risk of developing PUD.

Is peptic ulcer disease hereditary?

Yes, there is a genetic element to PUD. Although a bacterial infection causes it, people with certain genes are more likely to develop an ulcer due to the way their body reacts to H. pylori.

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