Difference Between Ulcer and Acid Reflux

Peptic ulcers and acid reflux are two common conditions occurring in the gastro-esophageal tract. Some people mistakenly confuse with these two terms as they are referring to the same because increased acidity is responsible factor for both. This article points out the differences between peptic ulcer and acid reflux with regard to etiology, pathology, clinical presentation, complications, investigation findings and management that would help one to differentiate between these two conditions.


Peptic ulcers can occur in the lower esophagus, stomach, duodenum, jejunum and rarely in the ileum adjacent to the Mickel’s diverticulum. The ulcers can be acute or chronic.

Peptic ulcers can be resulted from a variety of causes, which are broadly categorized as due to hyper secretion of acid, decreased mucosal resistance to acid, and Helicobacter pylori infections.

Peptic ulcer disease is chronic, with remissions and relapses, which is associated with healing and reactivation of the ulcer. Clinically patient presents with recurrent abdominal pain especially in the epigastric region, relationship with food and episodic occurrence. Vomiting may be an associated feature.

Complications of peptic ulcers include hemorrhage, perforation, pyloric obstruction and penetration. Endoscopy and biopsy helps in confirming the diagnosis. Management mainly aims at relieving the symptoms, inducing healing and preventing recurrences.

Acid Reflux

Reflux of acid occurs due to several reasons. They include reduced lower esophageal sphincter tone, hiatus hernia, delayed esophageal clearance, the composition of the gastric contents, defective gastric emptying, increased intra abdominal pressure such as in obesity and pregnancy, dietary and environmental factors such as alcohol, fat, chocolate, coffee, smoking and non steroidal anti inflammatory drugs.

Clinically patient with acid reflux can present mainly with heart burn and regurgitation. They may have increased salivation due to reflex salivary gland stimulation. Weight gain is a feature. 

In long standing cases, patient might develop dysphagia probably due to benign acid stricture formation in the esophagus. The other complications include esophagitis, Barrett’s esophagus, anemia due to chronic-insidious blood loss, gastric volvulus, and adenocarcinoma of the gastro esophageal junction in more complicated cases. Any patient with long-standing acid reflux, if developed dysphagia sometime in their lifetime, should be investigated for adenocarcinoma before the diagnosis of acid stricture is being made.

Endoscopy grades gastro-esophageal reflux disease into five grades. Grade 0 is considered to be normal. Grade 1-4 includes erythematous epithelium, streaky lines, confluent ulcers and Barrett’s esophagus respectively.

Management includes life style modifications, antacids, H2 receptor blockers and proton pump inhibitors, the last being considered as the treatment of choice. In case the medical management fails, surgical options have to be considered such as fundoplication.


What is the difference between ulcer and acid reflux?

• Peptic ulcers are resulted from H.pylori infections, non steroidal anti inflammatory drugs, smoking, and reduced mucosal resistance, while acid reflux is resulted from reduced lower esophageal sphincter tone, hiatus hernia, delayed esophageal clearance, defective gastric emptying, obesity, pregnancy, dietary and environmental factors.

• Peptic ulcer disease is chronic with remissions and relapses.

• Peptic ulcer patient usually presents with recurrent abdominal pain in relation to food while a patient with acid reflux presents commonly with heart burn.

• Complications of peptic ulcers include hemorrhage, penetration, perforation and pyloric obstruction while acid reflux can give rise to strictures, Barrett’s esophagus, anemia, gastric volvulus and adenocarcinoma.