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Health condition · Clinically reviewed

Peptic ulcers, explained simply - causes, symptoms and treatment.

Burning epigastric pain that wakes you at night is often a peptic ulcer. Most are caused by H. pylori or NSAIDs, and most heal fully with the right treatment.

For a deeper dive into causes, diagnosis and treatment, read our full peptic ulcer guide.

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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 and peer-reviewed sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK guidance on H. pylori eradication, PPI therapy and NSAID stewardship.

Key facts

Peptic ulcers at a glance.

The essentials, in plain English - what causes them, how they're spotted, and how they're 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).

  • Main causes

    Helicobacter pylori infection and NSAID use account for most peptic ulcers - together or alone.

  • Typical symptom

    Gnawing or burning epigastric pain, often related to meals or waking at night.

  • Diagnosis

    H. pylori testing plus endoscopy, especially over 55 or with alarm features.

  • Treatment

    Eradication therapy for H. pylori and acid suppression with a PPI - stop the causative NSAID where possible.

  • Same as

    This guide covers the same condition as our peptic ulcer page - read either for full detail.

Why this guide matters

Two causes, one clear treatment path.

Almost all peptic ulcers trace back to H. pylori infection, NSAID use, or both. Identifying which one is driving your ulcer shapes the whole treatment plan.

  • H. pylori is usually treatable

    A one-week course of eradication therapy clears the infection for most people and prevents recurrence.

  • NSAIDs are a common trigger

    Regular ibuprofen, naproxen or aspirin use damages the stomach lining - stopping or covering it with a PPI is key.

  • Bleeding is the main danger

    Most ulcers heal quietly, but bleeding or perforation are emergencies that need immediate care.

Diagnosis

How peptic ulcers are confirmed.

A GP will usually test for H. pylori first, then consider endoscopy depending on your age and any alarm symptoms.

  • H. pylori testing

    Urea breath test or stool antigen test, done off PPIs and antibiotics for reliable results.

  • Upper GI endoscopy

    A camera test that directly visualises and can biopsy an ulcer, particularly if you are over 55 or have alarm features.

  • Full blood count

    Checks for anaemia, which can indicate slow, ongoing bleeding from an ulcer.

  • Medication review

    A careful check of NSAID, aspirin and steroid use, since these are common contributing causes.

Symptoms

What a peptic ulcer feels like.

Epigastric pain is the classic feature - and the pattern of that pain can hint at whether it's a gastric or duodenal ulcer.

  • Epigastric pain

    Burning or gnawing pain in the upper abdomen - the hallmark symptom of a peptic ulcer.

  • Pain pattern with food

    Duodenal ulcer pain often eases after eating; gastric ulcer pain can worsen with food.

  • Night-time waking

    Pain that wakes you in the early hours is a classic peptic ulcer pattern.

  • Bloating and nausea

    Fullness, belching and nausea often accompany the pain.

  • Weight loss and appetite change

    Unintentional weight loss or reduced appetite deserves prompt investigation.

  • Red flag - bleeding

    Vomiting blood or black, tarry stools (melaena) signals a bleeding ulcer - this is an emergency.

Treatment

How peptic ulcers are treated in the UK.

Eradicate H. pylori where present, suppress acid with a PPI, and remove the NSAID trigger wherever possible.

  • H. pylori eradication

    A one-week course combining a PPI with two antibiotics clears the infection in most people.

  • Proton pump inhibitor

    Omeprazole or lansoprazole reduces acid and allows the ulcer to heal, usually over 4 to 8 weeks.

  • Stopping NSAIDs

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

  • Gastroprotection

    For patients who must continue NSAIDs, ongoing PPI cover reduces the risk of a further ulcer.

  • Endoscopic therapy

    Bleeding ulcers may need endoscopic clipping, injection or thermal treatment to stop haemorrhage.

  • Surgery (rare)

    Reserved for perforation, uncontrolled bleeding, or ulcers that fail medical management.

Want the full picture?

Our complete peptic ulcer guide covers eradication regimens, follow-up testing and recurrence prevention in more depth.

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 and gastro-oesophageal reflux disease.

  • NICE CKS. Helicobacter pylori infection.

  • British Society of Gastroenterology. Guidelines on the management of upper GI bleeding.

  • NICE. NSAIDs - safe prescribing.

Red flags

When a peptic ulcer needs urgent attention.

Most peptic ulcers heal with routine treatment. These situations do not - and need emergency or urgent care.

  • Vomiting blood (haematemesis)

    Fresh or coffee-ground vomit signals active bleeding - call 999 or attend A&E immediately.

  • Black, tarry stools (melaena)

    A sign of upper GI bleeding that has passed through the gut - needs urgent same-day assessment.

  • Sudden, severe abdominal pain

    Rigid, board-like abdominal pain can indicate perforation - a surgical emergency.

  • Unexplained weight loss

    Combined with dyspepsia, this warrants urgent two-week-wait referral for endoscopy.

  • Dysphagia

    Difficulty swallowing alongside ulcer symptoms needs prompt investigation to exclude malignancy.

  • Persistent vomiting

    Ongoing vomiting can indicate gastric outlet obstruction from scarring or a tumour.

Frequently asked

Everything we get asked about peptic ulcers.

Quick answers on causes, testing, eradication therapy and when to worry.

  • What is a peptic ulcer?

    A peptic ulcer is a break in the protective lining of the stomach (gastric ulcer) or duodenum (duodenal ulcer), most commonly caused by Helicobacter pylori infection or NSAID use.

  • Is this the same as a peptic ulcer?

    Yes. Peptic ulcers and peptic ulcer disease describe the same condition. For a fuller breakdown of causes, tests and treatment, see our dedicated peptic ulcer guide.

  • How is H. pylori tested for?

    A urea breath test or stool antigen test is used first-line. Endoscopy with biopsy may also identify H. pylori and confirm the ulcer directly.

  • Can peptic ulcers be cured?

    Most heal fully with H. pylori eradication therapy and a course of a proton pump inhibitor, particularly once NSAIDs are stopped or reduced.

  • What if I need to keep taking NSAIDs?

    Your GP may prescribe ongoing PPI cover alongside the NSAID, or suggest an alternative pain-relief option with lower ulcer risk.

  • When is an ulcer an emergency?

    Vomiting blood, passing black tarry stools, or sudden severe abdominal pain are emergencies - seek immediate medical attention.

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