Background <p>Peptic ulcer disease (PUD) is a common gastrointestinal disorder characterized by the formation of open lesions in the stomach or duodenum, leading to potentially life-threatening complications such as bleeding, perforation, and obstruction. Despite advances in understanding its pathophysiology and management, PUD continues to present significant health challenges, particularly in conflict-affected regions like Syria. This study investigates clinical presentation, demographic factors, and risk profiles associated with bleeding and perforated ulcers, aiming to contribute to evidence-based strategies for improving diagnosis and management in resource-limited settings.</p> Methods <p>A multicenter cohort study was conducted across five major hospitals in Syria from 2018 to 2023, enrolling 242 patients diagnosed with bleeding or perforated ulcers. Demographic data, clinical histories, lifestyle factors, and medical interventions were collected from hospital records. Statistical analyses, including Chi-square tests, t-tests, and logistic regression, were performed to identify associations between ulcer types, demographic variables, and clinical outcomes.</p> Results <p>Significant demographic differences were found between patients with bleeding and perforated ulcers. The bleeding group was older (mean age = 60.4 ± 18.7 years) compared to the perforation group (mean age = 49.4 ± 16.9 years), with rural residents more likely to experience bleeding ulcers (57.3%). Patients with a past history of peptic ulcer disease, gastritis, or other upper‑GI disorders were more likely to develop perforated ulcers, while those with multiple comorbidities were predisposed to bleeding ulcers. Lifestyle factors, such as occupation and smoking status, also influence ulcer type, with retired individuals more likely to develop bleeding ulcers and heavy smokers more often diagnosed with perforation. Clinical outcomes varied, with interventions predominantly consisting of open surgeries for perforated ulcers and laparoscopic approaches for bleeding ulcers.</p> Conclusion <p>This study highlights the complex interplay of demographic, clinical, and lifestyle factors in the presentation of bleeding and perforated peptic ulcers in Syria. The findings underscore the need for tailored, context-specific approaches in the management of PUD, particularly in conflict zones with limited healthcare access. This research provides valuable insights into predictors of ulcer type and complications, offering a foundation for evidence-based guidelines aimed at improving patient outcomes in resource-constrained settings.</p>