What Are Gastric and Duodenal Ulcers?

A peptic ulcer is an open sore or a break in the lining of the organs in the upper digestive tract (the esophagus, the stomach, and the first part of the small intestine called the duodenum).

Ulcers found in the stomach are called gastric ulcers. Those in the esophagus (the food pipe between the throat and the stomach) are called esophageal ulcers. Ulcers in the duodenum are called duodenal ulcers.

All of these ulcers fall into a category called peptic ulcer disease. The two most common types are gastric ulcers and duodenal ulcers. This article will discuss these two types of ulcers and how they are similar and different regarding symptoms, causes, diagnoses, treatments, complications, and outlook.

Gastric vs. Duodenal Ulcer Symptoms

When the lining of the stomach or duodenum breaks down, it can lead to the formation of an ulcer. The stomach and duodenum have a mucosal lining (made up of mucus) that protects them, but it can get worn down.

When that happens, the acids and enzymes used in digestion can eat away at the wall of the stomach or intestine and cause an ulcer. This erosion of the lining and then the wall can result in an open sore.

There may be some differences in the symptoms of duodenal and gastric ulcers. Duodenal ulcers are likely to present with abdominal pain a few hours after meals, when the stomach is empty (including nighttime abdominal pain). The pain usually gets better after eating.

Gastric ulcers may cause pain soon after eating, nausea, vomiting, and weight loss.

Common Ulcer Symptoms

Some ulcers cause no symptoms at all. Or symptoms may come and go if the ulcer heals and then flares up again.

An ulcer can cause symptoms of:

• Bloating
• Indigestion (dyspepsia)
• Nausea
• Stomach pain that feels like burning or gnawing
• Vomiting
• Weight loss

Less Common Ulcer Symptoms

In some cases, peptic ulcer disease can cause more serious or uncommon signs and symptoms. This might be likely when an ulcer is actively bleeding.

Some of the signs and symptoms of a bleeding ulcer are due to acute or chronic blood loss and include:

• Blood in stool or vomit
• Dizziness
• Fatigue
• Feeling light-headed
• Shortness of breath
• Weakness

Causes of Ulcers

There are several different reasons that an ulcer can form, including an infection, certain medications, or Zollinger-Ellison syndrome.

Helicobacter Pylori Bacteria

Helicobacter pylori (H. pylori) is a type of bacteria that many people have in their stomach. Usually, it doesn’t cause any problems. But sometimes this bacterium can grow out of control. The overgrowth can start to break down the stomach lining and cause ulcers. This cause of duodenal and gastric ulcers is common.

Medications

Other common reasons ulcers develop include long-term usage of nonsteroidal anti-inflammatory drugs (NSAIDs) or high doses of these medications. These drugs are available over the counter (OTC) and by prescription. NSAIDs can prevent the digestive tract against stomach acid. 

NSAIDs can also interfere with the ability of the blood to clot. Ulcers might bleed more if blood isn’t clotting effectively. 

There are many types of NSAIDs. Some of the more common brand name and generic versions are:

• Advil, Motrin (ibuprofen)
• Aleve, Naprosyn (naproxen)
• Aspirin
• Daypro (oxaprozin)
• Toradol (ketorolac)
• Zipsor (diclofenac)
  

Other medications that can cause ulcers include chemotherapy and osteoporosis medication like Fosamax (alendronate).

Zollinger-Ellison Syndrome

Zollinger-Ellison syndrome is a rare condition. In this syndrome, tumors form in the pancreas and/or the small intestine. Those tumors secrete a hormone called gastrin, which stimulates stomach acid production. The excess acid may lead to the formation of ulcers.

It’s estimated that this condition affects fewer than 1 to 3 people out of every 1 million. People are most often diagnosed between the ages of 20 and 50.

Other Causes

Stress or strong emotions are not a usual cause of ulcers. However, stress ulcers are seen in people with severe stress like traumatic brain injury (Cushing ulcer) and severe burns (Curling ulcer).

Crohn's disease, an inflammatory bowel disease, may also cause gastric and duodenal ulcers. Ischemia (decreased blood flow) can cause gastric and duodenal ulcers.

Risk Factors for Ulcers

There are certain factors that may cause a person to be at a higher risk of developing a peptic ulcer. These can include:

• Frequent use of NSAIDs
• Genetic predisposition
• Smoking

Diagnosing Gastric Ulcer vs Duodenal Ulcer

H. Pylori Tests

There are several different types of tests used to diagnose an infection with H. pylori. For these tests, you may be asked to stop taking antacids, proton pump inhibitors, and Pepto-Bismol (bismuth subsalicylate) for at least two weeks before. It might be necessary to wait up to four weeks after stopping an antibiotic before taking an H. pylori test.

A stool antigen test is commonly used to diagnose an H. pylori infection. Stool is collected and sent to a lab for testing.

The rapid urease test is done on a biopsy (a sample taken from the lining of the stomach). H. pylori produces an enzyme called urease. A high urease level could mean that there is an infection with H. pylori. 

To use the breath test for H. pylori, patients are given radioactive carbon to eat or drink. After doing that, the patient breathes into a sealed bag. The breath is then tested for the signs of an H. pylori infection.

Esophagogastroduodenoscopy (EGD)

An EGD is a type of endoscopy and might also be called an upper endoscopy. It is done by passing a flexible tube with a light and a camera on the end into the mouth and down into the stomach and the duodenum. The doctor that is doing the exam can see any ulcers that are in the stomach or the small intestine. 

During this test, biopsies (removing sample tissue for testing in a lab) can be performed and certain treatments can also be applied. An ulcer that’s bleeding could be cauterized (sealed by heat) or clamped. Medication can also be injected during an EGD. 

Upper Gastrointestinal Series

An upper gastrointestinal series is a type of X-ray that’s used to see the upper digestive system. It’s done by drinking a substance called barium. Barium does not interact with the body, so it passes through the digestive system, but it helps internal organs be seen on an X-ray. 

A series of X-rays are taken as the barium moves through the esophagus, stomach, and small intestine. This can show if there are any abnormalities, like an ulcer. An EGD might be used more often than this test.

Treatments for Gastric and Duodenal Ulcers

There are a variety of ways that ulcers can be treated. They include medication, lifestyle changes, and, in some cases, surgery. The treatments might be different based on the cause of the ulcer.

Lifestyle Changes

There are several lifestyle changes that might be recommended to help with the symptoms of a peptic ulcer. These can include:

• Avoiding alcohol
• Quitting smoking
• Avoiding dietary triggers, which could include fried foods, spicy foods, dairy, and citrus foods
• Not eating for two hours before going to bed
• Avoiding NSAIDs, if possible, in current users
  

Medications

A common type of medication used to treat ulcers are called proton pump inhibitors (PPIs). These drugs block the creation of the stomach acids that can lead to ulcers. They are taken within 30 minutes to one hour of having a meal. Many ulcers will heal with the use of a PPI.

Brands of PPIs include:

• Prilosec (omeprazole)
• Prevacid (lansoprazole)
• Protonix (pantoprazole)
• Aciphex (rabeprazole)
• Nexium (esomeprazole)
• Dexilant (dexlansoprazole)
• Konvomep (omeprazole and sodium bicarbonate)
  

PPIs are also used to treat Zollinger-Ellison syndrome. If surgery is needed, they might be used both beforehand and afterward.

Histamine receptor blockers are another form of medication that is used to treat ulcers. These drugs block histamine. Histamine is what signals the body to create stomach acid.

Brands of histamine blockers include:

• Axid AR (nizatidine)
• Pepcid (famotidine)
• Tagamet (cimetidine)

When the cause of the ulcer as an infection with H. pylori, antibiotics are used to clear the infection. The type of antibiotics that are used will be different based on several factors. The treatment will be tailored to the patient.

In May 2022, the Food and Drug Administration (FDA) approved two treatments for H. pylori infection in adults: Voquezna Triple Pak (vonoprazan, amoxicillin, clarithromycin) and Voquezna Dual Pak (vonoprazan, amoxicillin). Vonoprazan is a potassium-competitive acid blocker (P-CAB), and amoxicillin and clarithromycin are antibiotics used to kill the bacterium.

A person with Crohn's disease can also be treated for ulcers with anti-inflammatory medications, including biologic therapies.

Ulcer Surgery

Surgery for peptic ulcers can repair the damage done to the digestive system lining. It's not commonly done but may be needed if there are complications such as bleeding or a perforation.

For Zollinger-Ellison syndrome, surgery may be used to remove the tumors. This can also prevent tumors from spreading to other parts of the body. Medication might be used even after having surgery, if needed.

When to See a Healthcare Provider

It’s important to get treatment for ulcers. The symptoms of an ulcer, including abdominal pain, nausea, vomiting, and weight loss, are all reasons to see a healthcare provider.

For those who have been diagnosed with a peptic ulcer, it’s important to see a healthcare provider if any new symptoms develoop or if symptoms get worse.

This can include:

• Bloody stools
• Fainting
• Severe abdominal pain
• Vomiting blood
• Unexpected weight loss

Complications of Gastric and Duodenal Ulcers

There can be complications with peptic ulcer disease, although they are not common.

Bleeding

Ulcers are wounds so they might bleed. In some rare cases the bleeding can be serious. It’s important to be on the lookout for signs of bleeding such as blood in the stool, dark stool, or severe pain.

Perforation

A perforation is a hole in the lining of an organ in the digestive system. It is rare but it can be serious and lead to complications. Severe pain or other symptoms of an ulcer that suddenly get worse should be discussed with a healthcare professional.

Narrowing and Blockage

Gastric ulcers can cause narrowing if located at the end part of the stomach (the pylorus) and that can result in gastric outlet obstruction.

Duodenal ulcers can cause a narrowing in the small intestine. If the ulcer is in the part of the duodenum that connects to the stomach, it could result in inflammation or scarring that blocks food from moving through.

The symptoms can include vomiting, bloating, early satiety (feeling full), and pain. This is an emergency so if you think you have a blockage, seek medical care right away. 

Preventing Gastric and Duodenal Ulcers

Ulcers can’t always be prevented. But not smoking and limiting NSAIDs are a good idea for anyone who might be at risk for an ulcer. An infection with H. pylori can’t be prevented. It’s important to remember, also, that an ulcer is not caused by stress or eating certain foods.

Outlook With Gastric and Duodenal Ulcers

There are good treatments available for ulcers, and surgery usually is not necessary. It’s important to see a healthcare provider and to find out how to get an ulcer managed and healed. In most cases, ulcers from H. pylori or NSAIDs can be healed. Taking steps to prevent ulcers in the future may also be recommended.

Summary

Peptic ulcers include those in the stomach (gastric ulcers) and those in the first part of the intestine (duodenal ulcers). They can cause symptoms of pain, nausea, bloating, and vomiting. If an ulcer is suspected, there may be a need for diagnosis to determine the cause. There is a variety of treatments available that can help heal an ulcer.

A Word From Verywell

A lot of misconceptions about ulcers circulate, including that they are caused by stress or diet. Adopting an overall healthful lifestyle may be helpful in preventing certain types of ulcers from getting worse and in healing them.

However, some ulcers are not preventable. Getting treatment and healing ulcers when they do occur is important to avoid complications.