[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [General pathology](https://durgical.com/en/general-pathology/) › [Gastrointestinal tract](https://durgical.com/en/general-pathology/areas/gi/) › Peptic ulcer

# Peptic ulcer

- Lesion

A peptic ulcer is a deep crater in the stomach or duodenum, usually from H. pylori or painkillers; it can bleed, perforate or scar.

Updated Nov 12, 2026

## Key points

- Duodenal ulcer: antral H. pylori gastritis with more acid and less duodenal bicarbonate; gastric ulcer: weaker mucosal defence.
- More than four in five are solitary, round, sharply punched out, with flat or slightly overhanging edges; heaped-up edges suggest cancer.
- Base layers: necrotic fibrinoid debris, neutrophils, granulation tissue, fibrous scar with thick, sometimes thrombosed vessels.
- Complications: bleeding (most frequent), perforation (most deaths), obstruction from scarring (mostly pyloric channel ulcers).
- Other risks: Zollinger–Ellison syndrome, cocaine, steroids with NSAIDs, cirrhosis, COPD, CMV and herpes infection.
- Gastric mucosal atrophy protects against antral and duodenal ulcers because acid is low.

## What it is

Peptic ulcer disease is chronic ulceration, extending through the muscularis mucosae, of mucosa exposed to acid and pepsin. Almost all cases are linked to H. pylori, NSAIDs or smoking, and they develop on a background of chronic gastritis. The commonest site is the first part of the duodenum, a few centimetres from the pylorus; gastric ulcers favour the lesser curvature near the junction of body and antrum. Acid from ectopic gastric tissue (Meckel diverticulum, inlet patch) can ulcerate other sites.

## Structure

- Gross: round to oval defect with a smooth clean base (peptic digestion of exudate) and folds radiating from the scar.
- Micro layer 1: thin fibrinoid necrotic debris.
- Layer 2: active neutrophilic infiltrate.
- Layer 3: granulation tissue with new vessels and mononuclear cells.
- Layer 4: fibrous or collagenous scar, with thickened arteries that can bleed.
- Duodenal foveolar (gastric) metaplasia at the edges in chronic disease.

## Complications of peptic ulcer

| Complication | How often | What it means |
| --- | --- | --- |
| [Bleeding](https://durgical.com/en/conditions/upper-gastrointestinal-bleeding/) | The most frequent | Can be life-threatening and may be the first sign; a vessel in the scar erodes |
| [Perforation](https://durgical.com/en/conditions/peritonitis/) | Less common | Causes most ulcer deaths; free air under the diaphragm; chemical then bacterial peritonitis |
| Obstruction | Least common | Oedema or scar at the pylorus; cramps and vomiting |
| [Penetration](https://durgical.com/en/conditions/acute-pancreatitis/) | Variable | Into pancreas or liver; pain radiates to the back |

## Clinical notes

- Burning epigastric pain one to three hours after meals and at night, relieved by food or antacids (especially duodenal ulcer).
- Eradicating H. pylori and stopping NSAIDs has made recurrence uncommon.
- A gastric ulcer is biopsied to exclude cancer; duodenal ulcers are almost never malignant.

## Memory aid

Debris, neutrophils, granulation, scar: read the ulcer bed from top to bottom like four floors of a building.

## Test yourself

Think of the answer, then tap the question to see it.

## Where are peptic ulcers most often found?

In the proximal duodenum, within a few centimetres of the pylorus; gastric ones favour the lesser curvature near the body–antrum junction.

## Which complication of peptic ulcer causes most deaths?

Perforation; bleeding is more frequent but causes fewer deaths.

## Which gross feature suggests a malignant rather than a peptic ulcer?

Heaped-up, irregular margins; peptic ulcers have flat, punched-out edges.

## What forms the base of a chronic peptic ulcer?

Granulation tissue over a fibrous scar, beneath a layer of necrotic debris and neutrophils.

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## Elsewhere in DurgiPedia

- [Gastric acid secretion](https://durgical.com/en/physiology/gastric-acid-secretion/)

## Connections

## Related 6

- [Helicobacter pylori gastritis](https://durgical.com/en/general-pathology/helicobacter-pylori-gastritis/)
- [Acute gastritis and stress ulcers](https://durgical.com/en/general-pathology/acute-gastritis-and-stress-ulcers/)
- [Hypertrophic gastropathies: Ménétrier, Zollinger–Ellison](https://durgical.com/en/general-pathology/hypertrophic-gastropathies-menetrier-zollinger-ellison/)
- [Gastric adenocarcinoma: intestinal vs diffuse](https://durgical.com/en/general-pathology/gastric-adenocarcinoma-intestinal-vs-diffuse/)
- [Patterns of acute inflammation: serous, fibrinous, purulent, abscess, ulcer](https://durgical.com/en/general-pathology/patterns-of-acute-inflammation-serous-fibrinous-purulent-abscess-ulcer/)
- [Granulation tissue and scar formation](https://durgical.com/en/general-pathology/granulation-tissue-and-scar-formation/)

## Related conditions 8

- [Peptic ulcer disease](https://durgical.com/en/conditions/peptic-ulcer-disease/)
- [Helicobacter pylori gastritis](https://durgical.com/en/conditions/helicobacter-pylori-gastritis/)
- [Upper gastrointestinal bleeding](https://durgical.com/en/conditions/upper-gastrointestinal-bleeding/)
- [Zollinger-Ellison syndrome (gastrinoma)](https://durgical.com/en/conditions/zollinger-ellison-syndrome/)
- [Peritonitis](https://durgical.com/en/conditions/peritonitis/)
- [Iron deficiency anaemia](https://durgical.com/en/conditions/iron-deficiency-anaemia/)
- [Infantile hypertrophic pyloric stenosis](https://durgical.com/en/conditions/infantile-hypertrophic-pyloric-stenosis/)
- [Meckel diverticulum](https://durgical.com/en/conditions/meckel-diverticulum/)

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Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.

Sources: [Peptic Ulcer Disease](https://www.ncbi.nlm.nih.gov/books/NBK534792/) (StatPearls (NCBI Bookshelf), 2025); [Peptic ulcer: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/000206.htm) (MedlinePlus, US National Library of Medicine, 2025).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/general-pathology/peptic-ulcer/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/general-pathology/peptic-ulcer/