Peptic Ulcer Disease: Causes, Symptoms, and Treatment
Medically reviewed by Sumiran Racherla, MD, Internal Medicine. Last reviewed: October 23, 2026.
What kind of doctor treats Peptic Ulcer Disease?
A gastroenterologist, a doctor who treats the stomach and bowels, often treats peptic ulcer disease. An internist, a doctor who cares for adults, may start the care. A direct primary care or concierge doctor can be a first stop for an evaluation and can refer you to a specialist when needed.
What is peptic ulcer disease?
A peptic ulcer is an open sore or raw area in the lining of the stomach or the first part of the small intestine. A gastric ulcer is in the stomach. A duodenal ulcer is in the first part of the small intestine.
Symptoms
Belly pain, often in the upper middle belly, is a common symptom. The pain can differ from person to person, and some people have no pain. The pain may happen:
- In the upper belly.
- At night, enough to wake you up.
- When your stomach is empty, often 1 to 3 hours after a meal.
Other symptoms may include:
- A feeling of fullness and trouble drinking as much fluid as usual.
- Nausea or vomiting.
- Ongoing heartburn.
Small ulcers may not cause any symptoms and may heal without treatment. Some ulcers can cause serious bleeding.
Causes and who gets it
The most common cause of ulcers is infection of the stomach by bacteria called Helicobacter pylori, or H. pylori. Most people with peptic ulcers have these bacteria living in their digestive tract. Still, many people who have the bacteria do not develop an ulcer. These things raise your risk of a peptic ulcer:
- Drinking too much alcohol.
- Regular use of aspirin, ibuprofen, naproxen, or other nonsteroidal anti-inflammatory drugs (NSAIDs), which are common pain medicines.
- Smoking cigarettes or chewing tobacco.
A rare condition called Zollinger-Ellison syndrome makes the stomach produce too much acid. This leads to stomach and duodenal ulcers.
How doctors diagnose it
Your doctor may ask about your symptoms, your past ulcers or H. pylori infections, and the medicines you take, especially NSAIDs. During a physical exam, a doctor most often checks for swelling in your belly. The doctor also listens to your belly with a stethoscope and taps on it to check for pain. Blood, stool, and urea breath tests can check for H. pylori infection.
Doctors may order an upper GI endoscopy to confirm an ulcer and try to find its cause. An endoscope is a flexible tube with a camera. It lets the doctor see the lining of your esophagus, stomach, and duodenum.
Treatment
Doctors usually recommend medicines to help the ulcer heal. They also look for the cause of the ulcer and treat or manage it. The medicines include proton pump inhibitors (PPIs), H2 blockers, and other medicines. Doctors treat an H. pylori infection with a combination of medicines. These most often include two or more antibiotics and a PPI. In some cases, bismuth subsalicylate is added. Take all doses exactly as your doctor prescribes. If you stop early, some bacteria may survive in your stomach. Your doctor may test again at least 4 weeks after you finish the antibiotics.
If NSAIDs caused the ulcer, your doctor may suggest a change. You might stop them, take a different one, take a lower dose, or use a different pain medicine. If you need to keep taking NSAIDs, your doctor may recommend a PPI too. Taking medicines and treating the cause heals most ulcers. If an ulcer does not heal, smoking can slow healing, so your doctor may recommend that you quit. In rare cases, doctors may recommend surgery for ulcers that do not heal.
When to see a doctor
Call 911 or go to the emergency room if you vomit blood or have blood in your stool, especially maroon or dark, tarry black stool. Also call if you have sudden, sharp belly pain, a rigid, hard belly that hurts to touch, or you faint or feel confused. A hole in the stomach or duodenum is called a perforation, and it is a medical emergency. Contact your provider if you have ulcer symptoms.
How a direct primary care or concierge doctor fits in
A direct primary care doctor charges a flat monthly fee instead of billing insurance, while a concierge doctor usually charges more and often works alongside insurance. A direct primary care doctor can review your symptoms and medicines. They can order first tests and help coordinate care with a gastroenterologist.
Common questions
Does peptic ulcer disease always cause pain?
No, some people have no pain. Small ulcers may not cause any symptoms and may heal without treatment.
How long does treatment for an ulcer with H. pylori take?
The standard treatment uses combinations of medicines for 7 to 14 days. Your doctor may test you again at least 4 weeks after you finish the antibiotics.
What happens if I stop my ulcer medicine early?
Some H. pylori bacteria may survive and stay in your stomach if you stop your medicine early. The bacteria may also develop antibiotic resistance, which means the antibiotics may stop working against them.
When do doctors use surgery for a peptic ulcer?
In rare cases, doctors may recommend surgery for ulcers that do not heal. Surgery may also be needed if bleeding cannot be stopped with an endoscopy or by a radiologist. It may also be needed if the ulcer has caused a tear in the stomach or duodenum.
Can a peptic ulcer come back?
Yes, peptic ulcers tend to come back if they are not treated. If you take your medicines and follow your provider's advice, you will be much less likely to get another ulcer.
Sources
- MedlinePlus - Peptic ulcer
- National Institute of Diabetes and Digestive and Kidney Diseases - Diagnosis of Peptic Ulcers (Stomach or Duodenal Ulcers)
- National Institute of Diabetes and Digestive and Kidney Diseases - Treatment for Peptic Ulcers (Stomach or Duodenal Ulcers)
Medical Disclaimer
This content is for general educational and informational purposes only and is not medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment, and reading it does not create a doctor-patient relationship. Always seek the advice of your physician or another qualified health provider with any questions about a medical condition, and never disregard or delay seeking professional advice because of something you read here. If you think you may have a medical emergency, call 911 (or your local emergency number) immediately.
