Alternative names: Gastric ulcer, stomach ulcer, duodenal ulcer
A peptic ulcer is a sore in the protective mucosal lining of the gastrointestinal (digestive) tract, and develops when the lining is damaged. The digestive acids and enzymes secreted by the stomach cells eat away at the wall of the stomach or upper small intestine, forming an ulcer.
There are two subtypes of peptic ulcers:
- Gastric ulcers, where the stomach lining is affected; and
- Duodenal ulcers, which involves the top section of the small intestine.
Who gets peptic ulcers?
Approximately 10% of people develop peptic ulcer disease (PUD) in their lifetime. Both sexes are affected, with some sources indicating that men have a higher risk for peptic ulcers than women. Ulcers are most common in adults, but they do occur in children, too. Critically ill children in the intensive-care setting are particularly at risk.
Ulcers may also occur in people with burns (Curling’s ulcers), central nervous system conditions such as brain tumours or injuries (Cushing ulcers), and severe medical illnesses (e.g. sepsis, hypotension, respiratory failure and multiple trauma injuries).
The worldwide prevalence of PUD is changing – a result of changing patterns in Helicobacter pylori infection (see "Causes of peptic ulcers?"), increased use of non-steroidal anti-inflammatory drugs (NSAIDs), and an ageing population.
In most developed countries (e.g. Europe, the United States and Japan), the incidence of peptic ulcers is decreasing in the general population, thanks to improved sanitation and better methods of H. Pylori detection and eradication. However, the rate of hospitalisation and deaths related to PUD remains high among elderly people who reside in these countries – a result of high levels of H. Pylori infection and the use of NSAIDs.
In developing countries, it’s estimated that as much as 95% of the population are infected with H. pylori. Recent research on the global prevalence of H. pylori infection indicated that over 42 million South Africans (about 77.6% of the population) are infected. In 2015, around 4.4 billion people across the globe were affected. H. pylori infection is also still very common in the Far East.
Research shows that more than 20% of people with PUD have a family history of the condition, compared to only 5-10% in control groups.
Causes of peptic ulcers
Reviewed by Dr Estelle Wilken, senior specialist in Internal Medicine and Gastroenterology at Tygerberg Hospital. December 2017.