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Health condition · Clinically reviewed

Peptic ulcer, H. pylori, NSAIDs - and knowing when it's an emergency.

A gastric or duodenal ulcer is common and usually treatable in weeks. The pattern of pain, the cause, and a small number of warning signs decide the plan.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against NICE CKS, NICE guidance and peer-reviewed sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK guidance including H. pylori eradication regimens and endoscopic follow-up.

Key facts

Peptic ulcer at a glance.

The essentials, in plain English - what it is, what causes it, and how it's investigated and treated in the UK today.

  • What it is

    A break in the lining of the stomach (gastric ulcer) or first part of the small bowel (duodenal ulcer) that penetrates the muscularis mucosae.

  • Main causes

    H. pylori infection and NSAID use account for the great majority of cases - the two often overlap.

  • Less common causes

    Zollinger-Ellison syndrome (gastrin-secreting tumour) should be considered in severe, recurrent or atypical disease.

  • Gastric vs duodenal

    Gastric ulcer pain is often worse with eating; duodenal ulcer pain is often relieved by eating and worse at night or when hungry.

  • Testing for cause

    Stool antigen test or urea breath test for H. pylori, or biopsy taken at endoscopy.

  • Why gastric ulcers differ

    Gastric ulcers are biopsied to exclude malignancy and need a repeat endoscopy to confirm healing - duodenal ulcers do not routinely.

Why this guide matters

Find the cause, and the ulcer usually heals.

Peptic ulcers are common, well understood, and treatable once the cause is identified. The three points below shape everything else on this page.

  • Two causes explain most cases

    H. pylori infection and NSAID use are behind the great majority of peptic ulcers - treating the cause is the treatment.

  • Gastric ulcers need extra care

    Because a small proportion can mask an underlying cancer, gastric ulcers are always biopsied and re-scoped to confirm healing.

  • A few symptoms change everything

    Bleeding or sudden severe pain turns a routine ulcer into an emergency - recognising these early saves lives.

How the diagnosis is made

From first pain to a confirmed diagnosis.

The steps a UK GP or gastroenterologist will normally follow, in order - so you know what to expect and why.

  1. 01

    Assessing

    History and symptom pattern

    Epigastric pain, its relationship to food, bloating, nausea and any weight loss or difficulty swallowing.

  2. 02

    Assessing

    Medication and lifestyle review

    NSAID, aspirin, steroid and anticoagulant use, alcohol intake and smoking status - all shape both cause and risk.

  3. 03

    Assessing

    Check for alarm symptoms

    Bleeding, anaemia, weight loss, dysphagia or a palpable mass change the urgency and route of referral.

  4. 04

    Confirming

    H. pylori testing

    Stool antigen test or urea breath test, done off proton pump inhibitors and antibiotics where possible for accuracy.

  5. 05

    Confirming

    Upper GI endoscopy (OGD)

    Arranged for alarm symptoms, persistent symptoms despite treatment, or when the diagnosis needs confirming directly.

  6. 06

    Preparing

    Biopsy of any gastric ulcer

    Gastric ulcers are always biopsied at endoscopy to exclude an underlying gastric cancer, even when they look benign.

  7. 07

    Preparing

    Repeat endoscopy to confirm healing

    Gastric ulcers are re-scoped after treatment to confirm the ulcer has healed - duodenal ulcers usually are not.

Typical timeline: a first visit to a confirmed diagnosis in one to a few weeks.

Symptoms

What a peptic ulcer actually feels like.

The classic pattern of epigastric pain related to food. And the features that mean it's time to seek emergency care.

  • Epigastric pain

    Gnawing or burning pain in the upper abdomen - the pattern with food often points towards gastric or duodenal origin.

  • Pain worse with eating

    Suggests a gastric ulcer - pain can start soon after a meal as acid production rises.

  • Pain relieved by eating, worse at night

    Classic for a duodenal ulcer - hunger pain that eases temporarily with food or antacids.

  • Bloating and fullness

    Early satiety and abdominal distension are common alongside the pain.

  • Nausea

    Nausea, and occasionally vomiting, can accompany an active ulcer.

  • Haematemesis

    Vomiting blood or coffee-ground material signals a bleeding ulcer - an emergency.

  • Melaena

    Black, tarry, offensive-smelling stool from digested blood - always needs urgent assessment.

  • Sudden, severe abdominal pain

    Sudden severe pain, especially with a rigid abdomen, can mean perforation - a surgical emergency.

Treatment

How peptic ulcers are treated in the UK.

Treating the underlying cause - H. pylori or NSAID use - alongside acid suppression, and emergency management if a complication develops.

  • H. pylori eradication therapy

    Triple therapy - a proton pump inhibitor plus two antibiotics - for around seven to fourteen days if H. pylori is confirmed.

  • Proton pump inhibitor (PPI)

    Reduces acid production and allows healing - continued for four to eight weeks depending on ulcer type and cause.

  • Stop or switch NSAIDs

    Where possible, stopping the causative NSAID or switching to paracetamol is central to healing and preventing recurrence.

  • PPI cover if NSAIDs are essential

    When an NSAID cannot be stopped, ongoing PPI cover reduces the risk of a further ulcer or bleed.

  • Confirmation of H. pylori clearance

    Retesting after eradication therapy confirms the infection has cleared, particularly if symptoms persist.

  • Endoscopic haemostasis

    For a bleeding ulcer, endoscopic treatment - injection, clipping or thermal therapy - controls the bleeding source.

  • Emergency surgery for perforation

    A perforated ulcer needs urgent surgical repair - this is a same-day surgical emergency.

  • Lifestyle advice

    Reducing alcohol and stopping smoking both improve healing rates and cut the chance of recurrence.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or gastroenterologist knows your history and can tell you which parts apply to you. If in doubt, get seen.

  • NICE CKS. Dyspepsia - unidentified cause; Dyspepsia - proven peptic ulcer.

  • NICE. Gastro-oesophageal reflux disease and dyspepsia in adults (CG184).

  • British Society of Gastroenterology. Guidelines on the management of H. pylori infection.

  • NICE. Upper gastrointestinal bleeding in over 16s (CG141).

Red flags

When a peptic ulcer needs urgent attention.

Most peptic ulcers are managed safely in primary care. These are the situations that aren't - and where emergency care is needed.

  • Haematemesis

    Vomiting blood or coffee-ground material needs same-day emergency assessment.

  • Melaena

    Black, tarry stool from a bleeding ulcer is an emergency - go to A&E.

  • Sudden severe abdominal pain

    Especially with a rigid or board-like abdomen - suspect perforation and seek emergency care immediately.

  • Signs of shock

    Dizziness, fainting, cold clammy skin or a racing pulse alongside GI symptoms suggest significant blood loss.

  • Unexplained weight loss

    With dyspepsia, this is an alarm feature that warrants urgent endoscopic assessment.

  • Dysphagia

    New difficulty swallowing alongside upper abdominal symptoms needs prompt investigation.

  • Iron-deficiency anaemia

    Unexplained anaemia can be the first sign of a slowly bleeding ulcer or, rarely, malignancy.

  • Persistent vomiting

    Ongoing vomiting can indicate gastric outlet obstruction from ulcer scarring.

  • Symptoms not settling with treatment

    Ulcer symptoms that persist despite PPI therapy and eradication need re-assessment and often repeat endoscopy.

Living with it

A treatable condition, once the cause is found.

Four things that make the biggest difference day to day - finishing your medicines, being careful with painkillers, cutting back on alcohol and smoking, and keeping follow-up appointments.

A quiet reminder

Most ulcers heal completely once the cause is treated.

Finishing the full course of treatment - not stopping when symptoms ease - is what makes healing last.

  1. 01 Medicines

    Finish the whole course

    Eradication therapy and PPIs only work fully if taken exactly as prescribed for the full course - stopping early risks treatment failure.

  2. 02 NSAIDs

    Be careful with painkillers

    Avoid ibuprofen, aspirin and other NSAIDs unless a doctor has said they are safe alongside protective treatment.

  3. 03 Habits

    Cut back on alcohol and smoking

    Both slow ulcer healing and raise the chance of recurrence - reducing or stopping helps considerably.

  4. 04 Follow-up

    Keep the repeat endoscopy if booked

    For a gastric ulcer, the follow-up scope confirming healing is not optional - it is how malignancy is excluded.

Frequently asked

Everything we get asked about peptic ulcers.

Quick answers on causes, testing, eradication therapy and when it becomes an emergency.

  • What is a peptic ulcer?

    A peptic ulcer is a break in the lining of the stomach (gastric ulcer) or the first part of the small bowel, the duodenum (duodenal ulcer). It happens when acid and digestive enzymes damage the lining faster than it can repair itself, most often because of H. pylori infection or NSAID use.

  • What is the difference between a gastric and a duodenal ulcer?

    Gastric ulcer pain is often worse soon after eating, while duodenal ulcer pain is often relieved by eating and tends to return at night or when hungry. Gastric ulcers also need biopsy to exclude cancer and a repeat endoscopy to confirm healing - duodenal ulcers usually do not.

  • How is H. pylori tested for?

    The two main non-invasive tests are a stool antigen test and a urea breath test. If you are already having an endoscopy, a biopsy can be taken and tested at the same time. Ideally, PPIs and antibiotics are stopped for a couple of weeks before testing to avoid a false negative.

  • What does H. pylori eradication therapy involve?

    Triple therapy - a proton pump inhibitor plus two antibiotics - taken together for around one to two weeks. It clears the infection in most people and significantly reduces the chance of the ulcer coming back.

  • Why do gastric ulcers need a repeat endoscopy but duodenal ulcers don't?

    Gastric ulcers can, rarely, be an early sign of stomach cancer, so a repeat endoscopy confirms the ulcer has fully healed and rules out malignancy. Duodenal ulcers carry a much lower cancer risk, so routine re-scoping is not needed once symptoms have settled.

  • What are the signs of a serious complication?

    Vomiting blood or coffee-ground material, black tarry stool, and sudden severe abdominal pain with a rigid abdomen all suggest bleeding or perforation. These need emergency care straight away, not a routine GP appointment.

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