Peptic Ulcers (Stomach and Duodenal Ulcers)
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A peptic ulcer is a sore that forms in the lining of the digestive tract. Depending on where it occurs, it is called either a gastric ulcer (in the stomach) or a duodenal ulcer (in the first part of the small intestine, known as the duodenum). Together, these are referred to as peptic ulcer disease. While peptic ulcers were once thought to be caused by stress or poor diet, we now know that most are caused by a bacterial infection or the long-term use of certain medications.
Peptic ulcers are common in Australia and, when identified and treated appropriately, most people recover fully. Understanding what causes these ulcers, how they are detected, and what treatment involves can help you feel more confident in seeking the care you need.
What causes a Peptic Ulcer?
The two most common causes of peptic ulcers are infection with Helicobacter pylori (H. pylori) and the regular use of non-steroidal anti-inflammatory medications (NSAIDs) such as ibuprofen or low-dose aspirin.
H. pylori is a bacterium that lives in the lining of the stomach and triggers inflammation that can, over time, damage the protective tissue. It is responsible for approximately 70% of gastric ulcers and around 90% of duodenal ulcers. Many Australians carry this infection without ever experiencing symptoms, but for those who develop an ulcer, treating the underlying infection is essential to prevent recurrence. You can read more about H. pylori on our dedicated Helicobacter pylori page.
NSAIDs interfere with the stomach’s natural defences, reducing its ability to maintain a protective lining against acid. When taken regularly or in high doses, this can lead to ulcer formation. People who take aspirin for cardiovascular reasons or anti-inflammatory medication for conditions such as arthritis may be at increased risk. Paracetamol does not carry the same risk and is generally considered a safe alternative for those with a history of peptic ulcer disease.
Stress, diet, and lifestyle factors such as smoking and alcohol use are not direct causes of peptic ulcers, though they can aggravate symptoms and slow healing.
How common are Peptic Ulcers?
Peptic ulcers can affect anyone, though they are more common in people over the age of 60, in those who take NSAIDs regularly, and in individuals with an H. pylori infection. In people carrying H. pylori, the lifetime risk of developing an ulcer is estimated at between 10 and 20 per cent. Stomach cancer is a less common but more serious complication associated with long-standing H. pylori infection, particularly in those with a family history of gastric cancer.
Recognising the symptoms
The most common symptom of a peptic ulcer is a burning or gnawing pain in the upper abdomen, below the breastbone. This pain can come and go, and may be temporarily relieved by eating or by taking antacid medication. In some people, certain foods make the discomfort worse.
Other symptoms may include a feeling of fullness or bloating after meals, nausea, loss of appetite, or unexplained weight loss. Duodenal ulcers in particular can cause discomfort that wakes a person from sleep.
Some people with a peptic ulcer have very few or no noticeable symptoms at all, which means the condition can go undetected until a complication arises.
When to seek urgent medical attention
Some symptoms indicate a more serious problem and require immediate medical care. If you experience a sudden and severe abdominal pain, notice blood in your vomit or stools (which may appear dark or tar-like), feel lightheaded or faint, or pass stools that are black in colour, you should seek urgent medical attention without delay. These may be signs of a bleeding ulcer or a perforation, both of which are medical emergencies.
How is a Peptic Ulcer diagnosed?
If your symptoms suggest a peptic ulcer, your doctor will likely arrange tests to confirm the diagnosis and to check for H. pylori infection.
Gastroscopy
A gastroscopy (also known as an upper endoscopy) is the most accurate way to diagnose a peptic ulcer. During this procedure, a specialist passes a thin, flexible tube with a small camera through the mouth and into the oesophagus, stomach, and upper small intestine. This allows direct examination of the lining and, if needed, the collection of small tissue samples (biopsies) for laboratory analysis. A gastroscopy can also be used to test for H. pylori at the same time. You can find detailed information about what to expect from this procedure on our Gastroscopy page.
Testing for H. pylori
In addition to gastroscopy-based testing, H. pylori can be detected through a urea breath test, a blood test, or a stool antigen test. The breath test is particularly useful for confirming whether treatment has successfully cleared the infection, as it produces a reliable result once antibiotics have been completed. A blood test can indicate current or previous exposure but is not used to confirm treatment success. Your gastroenterologist will advise which test is most appropriate for your situation.
Treatment for Peptic Ulcers
The approach to treatment depends on the underlying cause of the ulcer. Most peptic ulcers respond well to medication, and surgery is rarely required.
Treating H. pylori infection
Where H. pylori is identified, the recommended treatment in Australia is a combination of at least three medications: an acid-reducing agent together with two antibiotics, typically taken over seven days. This approach is effective in 80 to 90 per cent of cases when the full course is completed exactly as directed. If the initial treatment is unsuccessful, your gastroenterologist can guide further management and may have access to alternative medication regimens.
Treating H. pylori is important not only for healing the existing ulcer but also for significantly reducing the risk of the ulcer returning. Without eradication of the infection, there is a high likelihood of recurrence. Once successfully treated, the risk of reinfection is very low, at less than one per cent per year.
After completing treatment, a breath test is usually performed at least four weeks later to confirm that the infection has cleared. It is generally recommended that acid-reducing medication be withheld for at least two weeks before this test to ensure an accurate result.
Ulcers caused by NSAIDs
Where an ulcer has been caused or aggravated by the ongoing use of anti-inflammatory medications, your doctor may advise reducing the dose, ceasing the medication if clinically appropriate, or switching to a safer alternative. Acid-reducing medication is typically prescribed to support healing and protect the stomach lining while treatment is underway.
Lifestyle and dietary considerations
While lifestyle changes alone will not cure a peptic ulcer, certain adjustments can help manage symptoms and support recovery. Avoiding foods and drinks that trigger discomfort, including very fatty foods, spicy meals, coffee, and alcohol, eating smaller and more regular meals, stopping smoking, and not eating within several hours of bedtime can all contribute to symptom relief during healing.
Complications requiring further intervention
A small number of people develop complications from peptic ulcers that require more urgent treatment. Bleeding from an ulcer can range from a slow, low-grade bleed to a rapid, significant haemorrhage. A perforation occurs when an ulcer erodes entirely through the stomach or duodenal wall, allowing digestive contents to enter the abdominal cavity. Both are emergencies that require immediate hospitalisation. In most cases, these complications can be managed via gastroscopy, though surgery is occasionally required.
Peptic Ulcers and the link to Gastritis and indigestion
H. pylori infection can cause inflammation of the stomach lining known as gastritis, which may be present even in the absence of an ulcer. Gastritis does not always produce obvious symptoms, but it can contribute to a feeling of persistent indigestion or discomfort in the upper abdomen, sometimes referred to as dyspepsia. In many people, treating an underlying H. pylori infection improves these symptoms, though this is not universal. Some individuals continue to experience indigestion for other reasons, and further assessment may be warranted. You can read more about gastritis on our dedicated page.
Can Peptic Ulcers be prevented?
Preventing peptic ulcers largely involves reducing the key risk factors. Practising good hygiene, including thorough handwashing before eating and after using the bathroom, helps reduce the chance of acquiring H. pylori. For those who need to take anti-inflammatory medications regularly, using the lowest effective dose for the shortest time necessary, and discussing protective options with your doctor, can reduce the risk of ulcer formation.
If H. pylori is identified and treated before an ulcer has developed, early intervention can prevent one from forming. For those with a personal or family history of peptic ulcer disease or gastric cancer, a specialist assessment is worth discussing with your GP.
When to see a Gastroenterologist in Brisbane
If you are experiencing persistent upper abdominal discomfort, have been told you carry H. pylori, have a history of peptic ulcer disease, or are taking medications that may increase your risk, a consultation with a specialist gastroenterologist is a sensible step. Our gastroenterologists provide assessment, investigation, and management of peptic ulcer disease and related conditions at our Brisbane practice. Our team can arrange gastroscopy and H. pylori testing, interpret your results, and guide treatment to suit your individual circumstances.
If you have a GP referral and would like to make an appointment, please contact our practice directly.
If you are experiencing ongoing symptoms and are looking for answers, we encourage you to speak with your GP about a referral to see one of our gastroenterologists.
If you have received a referral to see one of our specialists, you can request an appointment, or contact our rooms directly on (07) 3321 1500.
This information has been sourced and adapted from education resources developed by
Last reviewed 20 March, 2026.
