Chronic peptic ulcer

Author: Elliot Weisenberg, M.D. (see Authors page)

Revised: 29 November 2016, last major update August 2012

Copyright: (c) 2003-2016,, Inc.

PubMed Search: chronic gastric ulcer[title]
Cite this page: Chronic peptic ulcer. website. Accessed December 11th, 2018.
Definition / general
  • Usually in pyloric-type mucosa along lesser curvature
  • 20% have coexisting duodenal ulcer
  • 5% are multiple
  • Mean age 50 years, but may occur in children
  • Multiple (~10) biopsies recommended to rule out malignancy

  • Symptoms:
    • Epigastric burning
    • Pain worse at night, within 1-3 hours after meals
    • Pain may decrease with food / alkali
    • Perforation associated with pain in back, left upper quadrant, chest
    • Usually impairs life but doesn’t shorten it
    • Heals in 15 years without treatment versus weeks with treatment
    • Complications: perforation, hemorrhage, obstruction, surgery
  • H2 blockers, proton pump inhibitors
Gross description
  • Usually sharply punched out defect with straight walls, NO heaped up margins
  • Size doesn’t predict malignancy
Gross images

Images hosted on other servers:

Various images

Microscopic (histologic) description
  • Muscle wall replaced by fibrous tissue
  • Serosal fibrosis
  • Hyperplasia of adjacent lymph nodes
  • Proximal mucosa may be overhanging
  • Distal mucosa may have ladder-like configuration
  • Accompanied by active and chronic inflammation, unless NSAID related

  • Active ulcers have 4 prototypical zones:
    • Surface neutrophils, bacteria, necrotic debris and possibly Candida
    • Fibrinoid necrosis at base and margins
    • Granulation tissue with chronic inflammatory cells
    • Fibrous or collagenous scars in muscularis propria with thickened blood vessels showing endarteritis obliterans

  • Healing ulcers:
    • Have regenerating epithelium over the surface
    • May have intestinal metaplasia, marked reactive changes
    • Rarely exhibits hyalinization (severe thickening, usually of submucosa, Arch Pathol Lab Med 1982;106:472)
Microscopic (histologic) images

Images hosted on other servers:

Various images

Differential diagnosis
  • Acute gastric ulcers due to severe systemic stress
  • Carcinoma (radiologically)