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What’s the Difference Between Gastric and Duodenal Ulcers?

What are gastric and duodenal ulcers?

Gastric and duodenal ulcers are two kinds of peptic ulcers. A peptic ulcer is a sore that’s on the inside of the stomach lining (gastric) or the upper part of the small intestine (duodenal).

A person can have one or both ulcers at the same time. Having both types is known as gastroduodenal.

How do symptoms differ?

One way of telling if you have a gastric or duodenal ulcer is figuring out where and when symptoms occur. As food travels, it can cause stomach pain at different times, depending where your ulcer is.

While the location of your symptoms can help determine if the ulcer is gastric or duodenal, sometimes the pain is called referred. This means a person may have pain away from where the actual ulcer area is.

But nearly 75 percent of the people who have gastric or duodenal ulcers don’t have symptoms, according to Mayo Clinic. In fact, these ulcers rarely cause severe symptoms.

Severe symptoms include:

Seek emergency medical attention if you feel stomach pain and any of the symptoms above.

What causes ulcers?

Helicobacter pylori bacteria (H. pylori)

H. pylori is the most common cause of gastric and duodenal ulcers. This bacterium damages the mucus that protects your stomach and small intestine, allowing for stomach acid to burn through. An estimated 30 to 40 percent of Americans get H. pylori, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

It’s unclear how this bacterium spreads, but researchers believe it’s mostly through unclean food, water, and eating utensils. People who carry H. pylori can also spread it through direct contact.

Many people get this bacterial infection as a child, but it rarely develops into a peptic ulcer. In fact, most people don’t see symptoms until they’re older, if at all.


People who use or rely on nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, and naproxen sodium, are more likely to develop peptic ulcers. NSAIDs can irritate and damage your lining. Acetaminophen, or Tylenol, isn’t included on this list.

Other conditions

A rare condition known as Zollinger-Ellison syndrome can cause gastric and duodenal ulcers. This condition causes cancerous and noncancerous tumors to develop in the stomach and duodenum.

Who’s more likely to develop ulcers?

While doctors often recommend NSAIDs for health conditions such as arthritis or joint inflammation, NSAIDs can increase your risk for developing peptic ulcers.

Other risk factors known to increase your risk for developing gastric and duodenal ulcers include:

Spicy foods don’t increase your risk for ulcers but they can irritate your stomach further. Additional medications that may increase your risk for gastric and duodenal ulcers include:

How will your doctor diagnose ulcers?

Your doctor will start by asking about your medical history and symptoms. Let your doctor know when you start feeling the symptoms and where. Gastric and duodenal ulcers will cause pain in different parts of your abdomen. If your doctor suspects you may have an ulcer, they will usually confirm with several tests.

If a doctor thinks H. pylori may have caused the infection, the following tests can confirm or rule out this possibility:

  • Blood test: The presence of certain infection-fighting cells could mean you have an H. pylori infection.
  • Stool culture: A stool sample is sent for lab testing. H. pylori bacteria will grow over the course of a few days, if present.
  • Urea breath test: A urea breath test involves swallowing a pill that contains carbon and breathing into a bag that’s sent to a lab. High levels of carbon dioxide can indicate presence of H. pylori.

Esophogastroduodenoscopy (EGD)

An EGD test involves inserting a special tool known as a scope that has a lighted camera on its end through your mouth. The camera takes pictures as it moves down your stomach into the beginning of your small intestine. Your doctor will use these pictures to look for ulcers or other abnormal areas.

Upper gastrointestinal series

Your doctor may also order a test called a barium swallow or an upper GI series. This test involves drinking a solution with a small amount of radioactive matter. Your doctor will then take several X-rays to see how the solution moves through your digestive system. This allows the doctor to examine the X-ray for any potential abnormalities in the stomach.

How are ulcers treated?

Treatment for gastric and duodenal ulcers depends upon the causes and how severe your symptoms are. For example, your doctor may prescribe histamine receptor blockers (H2 blockers) or proton pump inhibitors (PPIs) to reduce the amount of acid and protect your stomach lining.

For H. pylori infections, your doctor will prescribe antibiotics and other medications to fight the bacteria and promote healing. These medications include mucosal protective agents, which help protect your stomach’s mucus lining.

If NSAIDs caused the peptic ulcer, a doctor will advise you on how to reduce your use.

If the ulcer is actively bleeding, your doctor can use special tools to stop the bleeding through an endoscope during the EGD procedure.

In cases that medication or endoscopic therapy does not work, your doctor may recommend surgery.

If the ulcer becomes deep enough to cause a hole in the wall of your stomach or duodenum, it becomes a medical emergency and surgery is most often required to fix the problem.

What’s the outlook for ulcers?

An untreated gastric or duodenal ulcer can develop into a serious problem, especially if you have existing symptoms.

The most common complications of ulcers are:

bleedingulcer wears away the stomach or small intestine and breaks the blood vessels there
perforationulcer breaks through the lining and stomach wall, causing bacteria, acid, and food to leak through
peritonitisinflammation and infection of the abdominal cavity due to perforation
blockagescar tissue can form as a result of the ulcers and keep food from leaving the stomach or duodenum

It’s important to get treated if you have symptoms related to gastric or duodenal ulcers.

In some cases, gastric ulcers can increase your risk for cancerous and noncancerous tumor growth. Duodenal ulcers aren’t usually associated with cancer.

Your doctor will recommend repeating an EGD after several weeks of treatment to confirm that the ulcers are healing. But most gastric and duodenal ulcers will go away with time and treatment.

Can ulcers be prevented?

You can reduce your risk for ulcers by lowering your intake of NSAIDs or switching to another medication, if you’re taking NSAIDs.

Other methods for prevention include:

  • Take NSAIDs with meals or medications that protect your stomach lining, if you need NSAIDs.
  • Avoid or limit caffeinated drinks and alcohol. They may worsen your symptoms.
  • Refrain from smoking, as it can slow healing.
  • Take all of your antibiotics, if prescribed, for H. pylori infections. Not taking the entire amount can bring the infection back.
  • Take steps to reduce the stress in your life. From sleeping more to taking time to do something you enjoy (reading, exercising, or writing in a journal), reducing stress can keep gastric and duodenal ulcer symptoms from getting worse.

Content licensed from:

Written by: Rachel Nall, RN, BSN, CCRN
Medically reviewed on: Oct 06, 2016: Graham Rogers, MD

This feature is for informational purposes only and should not be used to replace the care and information received from your health care provider. Please consult a health care professional with any health concerns you may have.
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