PUD stands for peptic ulcer disease, one of the most common abbreviations you’ll encounter on medical charts, lab reports, and doctor’s notes. It refers to open sores that develop in the lining of your stomach or the upper part of your small intestine (called the duodenum). These ulcers form when the protective mucus layer that shields your digestive tract breaks down, allowing stomach acid to eat into the tissue beneath.
How Peptic Ulcers Form
Your stomach produces strong acid to break down food, but it also maintains a thick mucus barrier to protect its own lining from that acid. PUD develops when something disrupts this barrier, leaving the tissue vulnerable. The ulcer isn’t just a surface scratch. It penetrates through the deeper muscular layer of the stomach or intestinal wall, which is why it can cause significant pain and, in some cases, bleeding.
There are two main types based on location. Gastric ulcers form in the stomach itself. Duodenal ulcers form in the first few centimeters of the small intestine, just past the stomach. Duodenal ulcers are more common overall, and the two types behave slightly differently when it comes to symptoms.
The Two Main Causes
Despite what many people assume, stress and spicy food don’t cause ulcers. The two primary culprits are a bacterial infection and a class of common painkillers.
H. pylori Infection
A spiral-shaped bacterium called Helicobacter pylori (H. pylori) is responsible for most peptic ulcers worldwide. It burrows into the mucus lining and triggers chronic inflammation, weakening the barrier that keeps acid away from the tissue. Many people carry H. pylori without ever developing symptoms, but in those who do develop ulcers, eliminating the infection is the cornerstone of treatment.
NSAIDs
Nonsteroidal anti-inflammatory drugs like ibuprofen, naproxen, and aspirin are the second most common cause. These medications work by blocking enzymes that produce compounds called prostaglandins. While that reduces pain and inflammation elsewhere in the body, it also strips away the prostaglandins your stomach relies on to maintain its protective lining and regulate blood flow to the tissue. Aspirin is particularly damaging because it permanently deactivates one of these enzymes rather than just temporarily slowing it down. NSAIDs also cause direct chemical injury to the cells lining the stomach, compounding the problem.
People who take NSAIDs regularly, especially at higher doses or over long periods, face a significantly elevated risk. Combining NSAIDs with other risk factors like smoking or heavy alcohol use raises the risk further.
What PUD Feels Like
The hallmark symptom is a burning or gnawing pain in the upper abdomen, roughly between the navel and the breastbone. The timing of that pain relative to meals can hint at the ulcer’s location. Gastric ulcers often cause pain during or shortly after eating, and food can sometimes make the discomfort worse. Duodenal ulcers behave differently: eating temporarily relieves the pain, but it returns two to three hours later, often waking people up at night when the stomach is empty.
Other common symptoms include bloating, nausea, loss of appetite, and a feeling of fullness after small meals. Some ulcers cause no noticeable symptoms at all and are only discovered when a complication occurs or during testing for something else. If an ulcer bleeds, you might notice dark, tarry stools or vomit that looks like coffee grounds.
How PUD Is Diagnosed
Doctors use a combination of testing for H. pylori and, when needed, direct visualization of the ulcer.
The simplest initial test is a urea breath test for H. pylori. You swallow a small capsule or liquid containing a tagged form of urea. If H. pylori is present in your stomach, the bacteria break down the urea and release a gas that shows up when you breathe into a collection device. This test is over 95% accurate. Stool tests that detect H. pylori proteins are another noninvasive option.
An upper endoscopy, where a thin, flexible camera is passed through the mouth and into the stomach, gives the most detailed view. Doctors can see the ulcer directly, measure its size, and take a small tissue sample (biopsy) to check for H. pylori or rule out anything more serious. You’re more likely to be referred for endoscopy if you’re older, have signs of bleeding, have lost weight unexpectedly, or aren’t improving with initial treatment.
Treatment and Recovery
PUD is highly treatable. The approach depends on the underlying cause.
If H. pylori is present, the goal is to wipe out the infection and reduce acid production so the ulcer can heal. The current standard recommended by the American College of Gastroenterology is a 14-day course combining an acid-reducing medication taken twice daily with three antibiotics. This regimen clears the infection in the vast majority of patients. After finishing treatment, you’ll typically be retested to confirm the bacteria are gone.
If NSAIDs are the cause, the first step is stopping the offending medication or switching to a safer alternative. Acid-reducing drugs are prescribed for several weeks to allow the ulcer to close. Most uncomplicated ulcers heal within four to eight weeks with proper treatment.
For both causes, acid-suppressing medications do the heavy lifting during recovery. These drugs dramatically reduce the amount of acid your stomach produces, giving the damaged tissue time to repair itself.
Complications Worth Knowing About
Most ulcers heal without incident, but untreated or severe PUD can lead to serious problems. Bleeding is the most common complication. A slow bleed might cause anemia over time, while a sudden, heavy bleed is a medical emergency. Perforation, where the ulcer erodes completely through the stomach or intestinal wall, is rarer but dangerous. Perforated peptic ulcers carry mortality rates as high as 30%, making prompt treatment critical.
Another possible complication is obstruction. Repeated cycles of ulceration and scarring near the outlet of the stomach can narrow the passage enough to block food from moving through. This causes persistent vomiting, significant weight loss, and a feeling of extreme fullness.
Diet, Smoking, and Lifestyle
One of the most persistent myths about ulcers is that you need to follow a bland diet to heal. Research doesn’t support this. The National Institute of Diabetes and Digestive and Kidney Diseases states that diet and nutrition do not play an important role in causing, preventing, or treating peptic ulcers, and doctors do not recommend avoiding specific foods or drinks for ulcer management.
Smoking is a different story. It slows ulcer healing, increases the risk of recurrence, and raises the likelihood of complications. Quitting is one of the most effective lifestyle changes you can make if you’ve been diagnosed with PUD. Limiting alcohol is also reasonable, since heavy drinking can irritate the stomach lining and worsen symptoms, even if it isn’t a primary cause of ulcers on its own.