Peptic Ulcer Disease (PUD) aka Duodenal Ulcer (DU) or Gastric Ulcer (GU)

Peptic ulcer disease (PUD) or duodenal or gastric ulcers are defined as an ulceration in the stomach or duodenum (first section of the small intestines) due to an imbalance between mucosal protective factors and various mucosal damaging mechanisms.


Approximately 250,000 to 500,000 cases are diagnosed every year!  Duodenal ulcers are more common (DU:GU = 4:1), with 200,000 to 400,000 of the annual cases being duodenal ulcers and 50,000 to 100,000 cases being gastric ulcers.


The cause of ulcers are usually multi-factorial, and the most common causes for ulcers are:

  • Helicobacter pylori infection: found in >70% of patients with DUs and GUs.  Eradication of H. pylori markedly reduces peptic ulcer recurrence
  • Medications such as glucocorticoids or NSAIDs
  • Alcohol
  • Smoking
  • Functional problem: incompetent pylorus or LES (lower esophageal sphincter)
  • Pathophysioloigcal problem: bile acids, impaired proximal duodenal bicarbonate secretion, decreased blood flow to gastric mucosa, acid secreted by parietal cells and pepsin secreted as pepsinogen by chief cells


The most commonly experienced signs and symptoms of peptic ulcer disease are:

  • Pallor
  • Tachycardia (increased heart rate) or hypotension (low blood pressure)
  • Nausea and/or vomiting; hematemesis (vomiting blood); epigastric (upper mid-abdomen) pain or tenderness that is described as burning, gnawing or hunger that may be relieved by foods or antacids; abdominal stiffness (board-like); or melena (black stools) 

Symptoms for gastric ulcers (GU) do not usually follow a consistent pattern.  For example, eating sometimes relieves the pain but other times aggravates the pain.

In comparison, duodenal ulcer (DU) symptoms are consistent.  The pain is not present upon waking up in the morning but does appear mid-morning; it is relieved by food but returns about 2-3 hours after a meal; and the pain commonly wakes up the patient overnight.


Always be aware of the following complications that may arise:

  • Hemorrhage (bleeding): the most common complication
  • PUD (peptic ulcer disease) recurrence
  • Confined penetration: the ulcer penetrates through the wall of the stomach or duodenum and enters an adjacent confined space or organ
  • Free penetration: the ulcer perforates through the duodenum or stomach (less common)
  • Stomach cancer
  • MALT lymphoma


The following diagnostic tools and results are often used or found when diagnosing peptic ulcer disease (PUD):

  • Endoscopy with biopsy for H. pylori
  • Biopsy of suspicious looking ulcers
  • Upper gastrointestinal (UGI) barium x-ray imaging studies
  • Possible presence of anemia
  • Urea breath test
  • H. pylori stool antigen
  • H. pylori IgA & IgG antibodies


From a Naturopathic standpoint, Dr. Moira Kwok ND will obtain a very thorough medical history in order to put all of your "puzzle pieces" together to form a whole picture of everything that is going on from a health perspective.  From this holistic approach to treatment, she will put together an individualized treatment plan based on a combination of dietary and lifestyle recommendations, supplements, botanicals, acupuncture and/or IV therapy that is based on your specific case. 



  • Beers MH & Berkow R (Editors).  1999.  The Merck Manual of Diagnosis and Therapy (17th Ed.).  Merck Research Laboratories: Whitehouse Station, NJ.
  • Ferri FF.  2007.  Ferri’s Clinical Advisor: Instant Diagnosis and Treatment.  Mosby Elsevier: Philadelphia, PA.