Peptic ulcer occurs when there is an inflammation on the inner lining of your stomach or duodenum. Often you will feel gastric pain, but you can’t always tell the severity of the ulcer by the level of pain. Sometimes there isn’t any pain at all. For example, about half of the ulcers caused by non-steroidal anti-inflammatory drugs (NSAIDs) that are diagnosed in elderly people are “silent,” with no symptoms at all. 

What do ulcers have to do with GERD? Sometimes the symptoms of an ulcer, such as indigestion and gastric pain, can appear the same as those for GERD, the doctors must differentiate their diagnosis to determine the treatment. 

It is also true that sometimes people have both an ulcer and GERD.    

Causes of peptic ulcer disease: – 

As mentioned, stress or a poor diet does not cause ulcers-although they can certainly make an existing ulcer feel a lot worse. Instead, ulcers have two primary causes. The majority are caused by the HP bacterium, which requires multiple antibiotics to combat it. Most other ulcers are caused by nonsteroidal anti-inflammatory medications taken for other illnesses such as arthritis. 

Although HP is the major cause of ulcers, complications occur more commonly with NSAIDS ulcers. Only a small minority of patients harboring HP or taking NSAIDs medications develop significant ulceration. Some studies have suggested that HP protects against NSAID-induced ulceration, while others claim the harmful effect is additive, but the jury is still out on this issue. 

Of course, not all ulcers are caused by the HP bacterium or by nonsteroidal anti-inflammatory drugs. A small percentage of ulcers are caused by a very rare disease, Zollinger-Ellison syndrome, which stems from a tumor that is usually sited on or around the pancreas and causes an extreme production of acid in the stomach. 

However, some ulcers have other causes. For example, an acute gastroduodenal ulcer may result from chemotherapy or radiation treatment, as well as from a virus or Crohn’s disease. The treatment is to take care of the gastric acid secretion with proton pump inhibitors, except that a viral ulcer requires specific antiviral drugs. 

How big is the problem? 

About a half-million people develop ulcers every year, and four million people have recurrences of ulcers. Some patients probably have recurrences because their HP has not been treated. Others have failed to take their medicine at all or for long enough. Other factors account for the remainder of treatment failures.

Peptic ulcers types 

If we go in detail, basically there are two types of peptic ulcers. The formation of gastric ulcer is in the stomach lining. Whereas, as the name signifies, the duodenal ulcer formation is in the duodenum, which is the first part of the small intestine, just beyond the stomach. 

Here are a few comparisons between the two types of ulcers: – 


Gastric Ulcer 

Duodenal Ulcer 

Epigastric pain

Pain within 30 minutes of a meal. 

Pain 2-3 hours after a meal and around midnight. 


Patients under eat because food causes pain. 

Patients overeat because food makes them feel better. 

Acidity of stomach 


About half of those with this type have high acid levels. 

Pain awakens the patient from sleep

Not usually 


Genetic cause 


Yes, 20 percent have a family history 


May be cancerous 

Extremely rare that it is cancerous. 

Follow-up endoscopy recommended 

Yes, to document healing. 

Usually not recommended. 

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