Peptic Ulcer Disease as a Cause of Chest Pain

Peptic ulcer disease is a common medical problem that is often mistaken for cardiac disease. Peptic ulcers often produce symptoms that can be a challenge to distinguish from angina or even the symptoms of a heart attack

In peptic ulcer disease, ulcers or sores are produced in the lining of the stomach, or of the duodenum (which is the first part of the small intestine). These ulcers are often quite painful.

A man experiencing chest pain.
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Pain Characteristics

Typically, the pain from peptic ulcer disease is perceived as abdominal pain—often pain in the pit of the stomach—but sometimes it can cause chest pain. It's often described as a burning or gnawing sensation.

Peptic ulcer pain is often relieved by eating a meal and often made worse by drinking alcohol, smoking, or ingesting caffeine. It can be accompanied by symptoms of:

  • Bloating
  • Gas
  • Nausea
  • Vomiting
  • Heartburn


Peptic ulcers can occur when the mucus that protects the lining of the upper digestive tract is diminished, or if the production of stomach acid is increased.

Conditions that produce peptic ulcers are most common in people whose digestive tracts are colonized by the Helicobacter pylori bacteria. Also, regular users of NSAID pain relievers have an increased risk of peptic ulcers.

Peptic Ulcer Disease vs. Angina

Usually, it's not particularly difficult for a healthcare provider to distinguish chest pain caused by peptic ulcer disease from angina caused by coronary artery disease (CAD). The characteristics of the two types of pain are usually quite different.

Peptic ulcer pain is not induced by exercise and relieved by rest (as the pain usually is in stable angina). The gnawing pain accompanied by bloating and nausea is quite different from that of stable angina.

Nonetheless, because angina itself can present in different ways, it may become important to do confirmatory tests to pin down the diagnosis.

Endoscopy (examining the GI tract with a special flexible scope) is the favored method of diagnosis of peptic ulcer disease, especially in people who have evidence of bleeding or have had severe symptoms.

Testing for the presence of Helicobacter pylori may also be helpful. X-rays of the upper digestive system may also be recommended.

If your healthcare provider is concerned about the possibility of CAD, a stress test may be helpful in distinguishing between these two problems.


Treating peptic ulcer disease often includes:

  • Antibiotics to get rid of the Helicobacter pylori bacteria. A two-week course of a combination of oral antibiotics is often used.
  • Drugs to block the production of stomach acid. These often include proton pump inhibitors such as Prilosec (omeprazole) and histamine (H2) blockers such as Zantac (formerly ranitidine, now famotidine).
  • Antacids to neutralize stomach acid.

April 1, 2020 Update: The Food and Drug Administration (FDA) announced the recall of all medications containing the ingredient ranitidine, known by the brand name Zantac.

The FDA also advised against taking OTC forms of ranitidine, and for patients taking prescription ranitidine to speak with their healthcare provider about other treatment options before stopping the medication. For more information, visit the FDA site.

In rare cases, a stomach ulcer fails to heal with such measures and surgery needs to be considered. However, with the medications that have been developed over the past few decades, surgery for peptic ulcer disease is far less common than it used to be.

3 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Gururatsakul M, Holloway RH, Talley NJ, Holtmann GJ. Association between clinical manifestations of complicated and uncomplicated peptic ulcer and visceral sensory dysfunction. J Gastroenterol Hepatol 2010; 25:1162. doi:10.1111/j.1440-1746.2010.06269.x

  2. Barkun A, Leontiadis G. Systematic review of the symptom burden, quality of life impairment and costs associated with peptic ulcer disease. Am J Med 2010; 123:358. doi:10.1016/j.amjmed.2009.09.031

  3. Fashner J, Gitu AC. Diagnosis and treatment of peptic ulcer disease and H. pylori infection. Am Fam Physician. 2015;91(4):236-42.

By Richard N. Fogoros, MD
Richard N. Fogoros, MD, is a retired professor of medicine and board-certified in internal medicine, clinical cardiology, and clinical electrophysiology.