VHOSPITAL.CLINIC · Differential Diagnosis
Gastritis vs Peptic Ulcer
Clinical comparison — shared symptoms, key differences, distinguishing diagnostic tests, treatment pathways, and when to seek urgent evaluation.
Condition Overview
Condition A
Gastritis
Gastritis is inflammation of the stomach lining, commonly caused by H. pylori infection, prolonged NSAID use, or excessive alcohol. It can be acute (sudden) or chronic (long-term) and may lead to peptic ulcers if untreated.
Condition B
Peptic Ulcer
Peptic ulcers are open sores that develop on the inner lining of the stomach or the upper part of the small intestine. H. pylori infection and long-term NSAID use are the most common causes. They cause burning stomach pain, especially when the stomach is empty.
Shared Symptoms — Why They're Confused
Both conditions present with 5 overlapping symptoms, making clinical differentiation essential.
Key Clinical Differences
Gastritis
- Epigastric pain/discomfort
- Nausea and vomiting
- Loss of appetite
- Heartburn
Peptic Ulcer
- Burning or gnawing epigastric pain worse on empty stomach (DU) or after eating (GU)
- Haematemesis or melaena if bleeding ulcer
- H. pylori often causative
- Relief with antacids
Distinguishing Diagnostic Tests
| Test | Gastritis | Peptic Ulcer |
|---|---|---|
| Endoscopy (OGD) | Erythematous, oedematous gastric mucosa without discrete lesion | Discrete mucosal break ≥5 mm depth in gastric or duodenal wall |
| H. pylori testing (CLO/urea breath) | May be positive (H. pylori gastritis) | Positive in >90% of duodenal ulcers, 70% of gastric ulcers |
| Full blood count | Normal (unless autoimmune gastritis causing B12 deficiency) | Anaemia if chronic blood loss from ulcer |
Treatment Approaches
Gastritis
- •PPI (omeprazole/lansoprazole)
- •H. pylori eradication if positive
- •Avoid NSAIDs and alcohol
Peptic Ulcer
- •PPI for 4–8 weeks
- •H. pylori triple therapy if positive (PPI + clarithromycin + amoxicillin)
- •Repeat endoscopy for gastric ulcer to exclude malignancy
- •Avoid NSAIDs
When Doctors Consider Each Diagnosis
🔵 Consider Gastritis when:
- →Diffuse mucosal discomfort without discrete lesion, often NSAID or alcohol-related
🟢 Consider Peptic Ulcer when:
- →Discrete epigastric pain pattern, possible haematemesis, endoscopy showing mucosal break
Explore Each Condition in Detail
Related Clinical Pages
Gastritis
Medical References
Content on this page is informed by evidence-based clinical sources including:
- World Health Organization (WHO)Global health guidance and disease classification
- National Health Service (NHS)UK clinical guidelines and patient information
- National Institute for Health and Care Excellence (NICE)Evidence-based clinical practice guidelines
- Centers for Disease Control and Prevention (CDC)US public health data and clinical recommendations
- PubMed – NCBIPeer-reviewed biomedical literature and clinical studies
- Cochrane LibrarySystematic reviews and meta-analyses in evidence-based medicine
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